Oral Answers to Questions

DEPUTY PRIME MINISTER

The Deputy Prime Minister was asked—

Regional Government

Claire Curtis-Thomas: What the relationship would be between an elected regional assembly and the Northwest Development Agency.

Phil Hope: The Northwest Development Agency would become directly accountable to the elected regional assembly rather than to central Government, but it would retain its present day-to-day operational independence. The assembly would appoint the chair and board members of the RDA, publish the regional economic strategy and set the agency's budget.

Claire Curtis-Thomas: I thank my hon. Friend for that reply. Will he join me in welcoming his Department's report, which was published on Monday, which recognised the contribution that our core cities strategy has made to investment and employment opportunities for cities such as Liverpool? Will he also acknowledge the role that the Northwest Development Agency has played in securing fantastic investment, certainly in my constituency, with a great impact on the sustainability of communities such as mine?

Phil Hope: The core cities have indeed been very successful. People are returning to our cities. In 2002–03, the Northwest Development Agency created or safeguarded more than 16,700 jobs in the region. In my hon. Friend's constituency, unemployment has dropped by no less than 54 per cent. since 1997. There is, however, still much to do to reduce the economic disparities in England, and unlike the Tories, who oppose anything with the word "region" attached to it, we believe that a new elected regional assembly in the north-west will be a real champion for the people of that region, bringing them more jobs and prosperity and giving local people democratic control over decisions and resources in their area.

George Osborne: What did Lord Rooker mean when he said that an elected regional assembly in the north-west would have no new powers and no new money?

Phil Hope: My noble friend Lord Rooker often speaks in the other Chamber and elsewhere forthrightly on these matters. He knows, and we know, that the powers of an elected regional assembly are widespread: they will not only have regional economic development as a major role, they will promote jobs and skills and have responsibilities for planning, housing, transport, arts, tourism, sport, fire and rescue, public health, rural regeneration, the environment, promoting the region in Europe, and sustainable development. That is the real job that regional elected assemblies will have, and unlike the Tories, we are backing them all the way.

Hilton Dawson: I wonder whether my hon. Friend is aware of the magnificent contribution that the Northwest Development Agency is making both to economic regeneration around Luneside and to the development of InfoLab at Lancaster university, which will be the hub of science-based business across the north of the north-west for many years to come. Is it not imperative for all the people of the north-west, and especially those living north of Lancaster, that we have an elected regional assembly to ensure ownership of such vital developments and proper integration of those superb regeneration initiatives throughout all the urban and rural areas of the region?

Phil Hope: My hon. Friend is absolutely right: the economic benefits to urban and rural areas of an elected regional assembly are there for us all to see, and we are giving the people of the north-west the choice. It seems odd to me that all the benefits that he has outlined are opposed by the Tories, who are against giving people a choice in this referendum, yet seem to wish to give them a choice in other referendums.

Edward Davey: The Minister should listen to Lord Rooker rather more carefully. If he really wants to promote economic development in the north-west and other regions, should not more power over economic policy be devolved, for example to learning and skills councils and in regional transport policy, giving regional assemblies real power to make a difference? Is not his and the Deputy Prime Minister's timidity on regional devolution in danger of producing a no vote in the autumn referendums?

Phil Hope: The hon. Gentleman once again ploughs this furrow. I wish his party was more consistent. The Liberal Democrats support devolution, for which we are grateful, as it gives power to the people in creating democratic institutions for the regions. We look forward to getting their support on the doorstep, backing the yes campaign—whether we in fact get it is a matter for them. I am quite clear where our party sits, and I certainly know where the Tories stand.

Caroline Spelman: The hon. Member for Crewe and Nantwich (Mrs. Dunwoody) said that there is no public demand for the proposed changes to local government resulting in the transfer of powers to regional assemblies. I feel a bit sorry for the Minister, who has to defend colleagues whose views differ from those of his Department. Does he think that she was right or wrong?

Phil Hope: I welcome the hon. Member for Meriden (Mrs. Spelman) to her post. I understand that she is leading her team, although we on the Government Benches get slightly confused about who in her party is doing what—no change there.
	The choice for the people of the northern regions—the north-west, the north-east and Yorkshire and Humber—is absolutely clear. Do they want their region to have a strong voice? Do they want democratic control of the resources and of the decisions made in their region? Do they want jobs and economic prosperity to come to their region through the creation of an elected regional assembly? That choice is absolutely clear, and my party supports it. I wish that the Conservative party would stand up for the north for once, rather than running it down.

Caroline Spelman: As the Minister will not say clearly why he thinks that the hon. Member for Crewe and Nantwich is wrong, perhaps I may tell him why I think that she is right. Why should people in the north-west be expected to foot the bill for a costly new tier of politicians that they neither want nor need, and that will not result in one extra nurse, doctor or teacher? At a time when trust in Government politicians is at an all-time low, why is the answer to create yet more bureaucrats, more regulations and more politicians?

Phil Hope: It seems that Conservative Front Benchers should talk to one another. The hon. Lady's colleague the Member for North Essex (Mr. Jenkin) announced on Monday that the Conservatives would scrap every single regional structure that they could find, despite the fact that Conservative councillors up and down the country are taking an active part in regional chambers and assemblies that are doing a good job. Moreover, he mentioned one or two proposals for local government, including a £2.5 billion cut in local government funding. How many nurses, teachers and police officers would that cut from front-line services? The hon. Lady needs to get a hold on her brief before she makes such an accusation in this Chamber.

Planning (Local Accountability)

Andrew Selous: If he will make a statement on local accountability in relation to the planning system.

Keith Hill: Under our plan-led system, local planning authorities are responsible for producing local plans and taking decisions on the vast majority of planning applications. The Office of the Deputy Prime Minister is reforming the planning system to achieve better and more up-to-date local plans, improve the processes for handling planning applications and ensure that local communities are involved in plan preparation from the outset. That will improve accountability, efficiency and effectiveness.

Andrew Selous: Why should the East of England regional assembly—unaccountable, unloved and unelected by those who are affected—dictate development policy? Why will the Government not trust local people to take the planning decisions that affect their environment through the local councillors whom they elect?

Keith Hill: I might point out that the East of England regional assembly, which the hon. Gentleman castigates so comprehensively, is dominated by his party. The fact is that those decisions are taken by elected representatives from his own party. However, let me say to the hon. Gentleman, who has been so persistent on this issue, that the people of south Bedfordshire for whom he speaks will benefit from the economic growth associated with the proposals for Luton airport, and that they cannot be immune from the housing consequences of that. This Government will ensure that the transport infrastructure is put in place, and we will start with brownfield. We will accept no strictures from a party that, when in government, allowed developers to rampage over the countryside.

John Mann: Can it be right that when some sandal-wearing lobbyists from London are the only objectors to new roundabouts on the A1, that automatically leads to a 12-month delay and a public inquiry, whereas when my constituent Mrs. Harvey and her councillor wish to object to a development in an adjoining property to hers, they are told that the decision will be taken by the local council on delegated authority because the Government have specified that 90 per cent. of all planning decisions must be made through delegated authority? Is that local democracy or is it not?

Keith Hill: My hon. Friend is in fine popular—one is tempted to say even populist—vein. We are seeking to ensure that sandal-wearers from any part of the country cannot unreasonably impede planning developments. That is one of the central proposals of the Planning and Compulsory Purchase Bill. My hon. Friend is right to say that a substantial number of lower-order—if I may put it that way—planning decisions are delegated, but that is essentially a matter for local authorities and elected representatives. It is open to his local authority and councillors, I dare say at his excellent behest, to change that system if they so desire.

James Paice: The Minister's words about local accountability and local consultation will ring pretty hollow with my constituents in the village of Cottenham, who have seen planning inspectors overrule local opinion and the local authority time and again to grant ever more Traveller permissions on greenfield sites over and above the 35 sites that have existed without dispute for many years. [Interruption.] It is not about Travellers; it is a matter of size. Why will the Government not take heed of local opinion about the number of people who can be integrated into a local community, and why do they consistently override the local accountability that the Minister apparently praises?

Keith Hill: I do not share the impatience of some Members with the concerns expressed by the hon. Gentleman. We have followed developments in Cottenham very carefully and we wholly understand the concerns that the hon. Gentleman is articulating. He will understand that those matters are still the subject of planning applications and in some cases before the courts, so it is difficult for me in my quasi-judicial capacity to express a view. Let me say, however, that we are aware that existing enforcement procedures are very time consuming, which is why the Planning and Compulsory Purchase Bill, to which I referred earlier, will introduce the option of temporary stop notices. They should be helpful in cases such as Cottenham. We will also emphasise the opportunities available to local authorities through planning guidance.

Clive Betts: Will my right hon. Friend assure me that the proposed changes to PPG6 on out-of-town shopping centres will not reduce the power of local authorities to refuse applications for them? In particular, will he assure me that developers will not have any greater ability to insist on one large single site for such developers, which naturally forces shopping centres out of town, and that local authorities will not have taken away from them their power to refuse extensions to centres such as Meadowhall in my constituency? If that were extended, it could damage not only Sheffield city centre, but Rotherham town centre and other district centres.

Keith Hill: These matters are subject to case-by-case decision making, and it would be wrong to issue a general directive against extensions or developments in any circumstances whatever. However, my hon. Friend should understand what we have achieved since we came to power in 1997, and realise the purposes of PPG6—and, indeed, the revised PPS6—which are to continue to resist greenfield development and to protect our inner-city areas and town centres. The fact remains that, as the planning permissions granted by the Conservatives for greenfield development begin to run out, we are seeing increasing development in city centre areas. So successful has the return to the city centre been in our major cities that we are now turning our attention to the second tranche of smaller towns and cities, where we want to encourage the same revitalisation that we have seen over the past six to seven years in the larger towns.

John Hayes: On the subject of planning and development, the Minister knows that the green belt was always intended to be a tight belt of land to prevent urban sprawl. Since 1997, however, it has been less a belt than a piece of elastic, as the green belt has expanded further into the open countryside and from the places it is supposed to protect. Given that the Library told me that answers thus far to questions on that matter have been "imprecise"—indeed, it described them as "evasive"— will the Minister tell me how much urban sprawl has taken place since 1997 and explain to the House how many acres of inner green belt have been developed under Labour?

Keith Hill: The answer is perfectly simple. Since the Government came to power, we have expanded the green belt by 25,000 hectares and there are plans to extend it by a further 12,000. It was the hon. Gentleman's party that allowed low-density development to destroy and concrete over our countryside, and it is the Labour Government who are committed to brownfield first. We are already achieving well above our 60 per cent. objective for development on brownfield sites, and we will continue with that purpose.

Planning Gain

Keith Vaz: What proposals he has to change the rules relating to planning gain.

John Prescott: May I first offer my congratulations to the hon. Member for Meriden (Mrs. Spelman) on her new portfolio?
	As part of our agenda to deliver sustainable communities we are reforming the planning system, through the Planning and Compulsory Purchase Bill, to make it fairer, faster and more predictable. The new approach will give developers the choice of either negotiating a traditional section 106 agreement or—if they want greater speed and certainty—to pay a fixed charge, thus avoiding lengthy negotiations. That will give the local authority greater resources to spend on new community facilities, infrastructure improvements and affordable homes.

Keith Vaz: I am sure that my right hon. Friend will be aware that last year Tesco made profits of £69,000 a minute. May I draw his attention to planning issues involving Tesco in the Hamilton area of my constituency, where it has put up a megastore but given only a paltry sum as part of the planning gain? Tesco also appears to be blocking the establishment of an independent chemist in the area and cannot even collect its own trolleys. Will my right hon. Friend look at that case to ensure that the rules governing planning gain are fair to local communities and local authorities?

John Prescott: I assure my hon. Friend that I have no power to collect trolleys. The issue that he mentions was not called in and is therefore a matter for the local authority and Tesco. However, I congratulate Tesco on providing more in-town retail shopping. In 1979, there were 150 out-of-town shopping areas, but that increased under the Conservatives to 1,100. We have changed the trend, and last year, for the first time, in-town shopping increased, with the consequent reduction in poverty and improvement in jobs.

Sydney Chapman: Given that many people think that section 106 agreements challenge the integrity of the planning system, because they involve the granting of planning permission in exchange for money, will the Deputy Prime Minister assure the House that any alternative to that system in the planning Bill will earmark any money collected for specific projects, which should begin as soon as practically possible?

John Prescott: The hon. Gentleman makes a sound point, and it is one that we have made in debates in this House and in the other place. It will be written into the Bill. Planning gain can be in money or in kind, such as in affordable housing or other facilities that might benefit the community. We have provided advice on the issue, but the hon. Gentleman makes a sound point and we intend to follow it up.

Green Belt

Tam Dalyell: What discussions he has had with the Scottish Executive on green belt policy.

Yvette Cooper: None: it is a fully devolved matter.

Tam Dalyell: Does my hon. Friend recognise the problem of some exceedingly prosperous and well managed firms somehow getting permission to put up offices and big buildings in green belt areas and then not quite keeping to the undertakings on the environment that they gave to get the permission?

Yvette Cooper: Companies certainly need to recognise their responsibilities towards the environment, the green belt and the planning system. It is possible for local planning authorities in England to put conditions on planning permissions, and if those conditions are violated, it is up to them to take enforcement action.

Emergency Services (London)

Roger Casale: What assessment he has made of the state of readiness of the fire service and other emergency services to deal with catastrophic events in London.

Nick Raynsford: Following the attacks on New York and Washington on 11 September 2001, a multi-agency team was set up to carry out an urgent and comprehensive review of London preparedness. Its report has formed the basis of the work of the London Resilience forum, which I chair with the Mayor of London as my deputy. The role of the forum is to ensure that London is as well prepared as possible to respond to a major attack or incident. The state of readiness of the emergency services is continually evaluated and tested through a series of exercises.

Roger Casale: All hon. Members will surely feel an abiding sense of horror at the sheer destructive force of the recent terrorist atrocities in Madrid. What lessons have been learned in this country from that attack, and what further steps have been taken to prepare London for a similar scale attack?

Nick Raynsford: I share my hon. Friend's horror at the appalling incidents in Madrid. Since the atrocity there, the Metropolitan police, Transport for London and other London front-line agencies have been in regular contact with their counterparts in Madrid to learn lessons and find out what more London could do both to prevent an attack and to respond to any consequences. We have also launched an awareness campaign, which had been planned before the Madrid attack and which has been very visible indeed on the London underground and in other transport locations in London, highlighting the need for awareness and preparedness. That is all part of the work that we are doing to ensure that we are as well prepared as we possibly can be.

Angela Watkinson: In the recent Madrid bombings, the Red Cross played a very prominent role, particularly in the humanitarian aspect of helping people after that atrocity. What discussions has the Minister had with the Red Cross in this country to take advantage of its network of people across the country who can come into the community if there is a parallel incident in London?

Nick Raynsford: I am pleased to tell the hon. Lady that the Red Cross and other voluntary agencies are regularly contacted by the London Resilience forum. Indeed, the voluntary sector is regularly represented as part of the planning in that forum to ensure the co-ordination of all those who would have a role to play in the event of any such incident.

Public Planning Inquiries

Tony Baldry: How many public planning inquiries he has ordered in the last 12 months.

Keith Hill: Altogether, arrangements were made for 2,163 public inquiries, mostly at the request of the parties, into appeals and other matters submitted under the Town and Country Planning Acts.

Tony Baldry: Of the Bicester accommodation centre, the then Minister for Citizenship and Immigration said at the Dispatch Box that the Government would abide by the outcome of any public inquiry, and went on to say that that would be both fair and democratic. The public inquiry took place; the inspector ruled on planning grounds that the development should not go ahead. The Deputy Prime Minister metaphorically put up two fingers to that and said that, because it was Government policy, the development would go ahead regardless. What on earth is the point of holding a public inquiry if the Government intend to take absolutely no notice of its outcome? What is either fair or democratic about that—or is it just as worthless as all the rest of the Government's big conversation?

Keith Hill: I must inform the hon. Gentleman that there was nothing extraordinary about the procedure adopted in the Bicester case. On average, the First Secretary of State disagrees with inspectors' recommendations in about 10 per cent. of cases. Last year, the figure was 31 out of 330 applications and appeals. In the Bicester case, the reasons for the First Secretary of State's decision are set out in his decision letter of 18 August 2003. There is nothing further to add to the reasons given in that decision. [Interruption.]

Mr. Speaker: Order. I ask the House to come to order.

New Deal for Communities

Jim Dobbin: What progress there has been on the New Deal for Communities programme; and if he will make a statement.

John Prescott: In the new deal for communities, we are investing more than £2 billion in 39 of our most deprived communities. After just four years, we have already seen significant achievements: employment in the NDC areas is down by 7 per cent., which is faster than the national average; pass rates for pupils who achieve five or more GCSEs are up by 5 per cent., which is higher than the national average; and crime is down by 14 per cent. That is a fantastic achievement, which the National Audit Office has called "pleasing", and it has made a real difference to people's lives. I am sure that the House will want to congratulate the 50,000 ordinary people who have been involved in achieving that success.

Jim Dobbin: Is my right hon. Friend aware of "Heart of Heywood", which is the new deal for communities programme in my constituency? It has just purchased five state-of-the-art buses to transport unemployed people to areas that are difficult to reach. Other plans in the pipeline include a new primary school and a community campus, which will deliver services from the police, housing authorities, the local library and other agencies, and a new health connections centre supported by the primary care trust, social services and Sure Start. Will my right hon. Friend make sure that all NDC projects throughout the country are well supported because they are helping to regenerate the poorer communities in our society?

John Prescott: I very much agree with my hon. Friend. My Ministers and I have visited the majority of NDCs, and we continue to do so. Indeed, I shall visit Shoreditch NDC on 28 May. My hon. Friend will be aware that I visited his constituency a couple of weeks ago, when I announced the £53 million investment in a pathfinder scheme for Rochdale and Oldham. I am certainly aware of the achievements of those in his NDC, and they are to be congratulated on them. They join the rank of successful NDCs, which we are proud of, and it shows that people have the money and they can make a difference—but if people vote for the Tories, they will slash those programmes in the future.

PRIME MINISTER

The Prime Minister was asked—

Engagements

Chris Bryant: If he will list his official engagements for Wednesday 21 April.

Tony Blair: Before announcing my engagements, I am sure that the whole House will want to join me in expressing condolences to the families of those Iraqis, including children, who were tragically murdered in a series of explosions in Basra this morning. I understand also that four British soldiers were wounded in the attacks, and our thoughts are with them and their families. Let us be clear. The majority of Iraqi people want a stable and democratic Iraq; these terrorists want to stop them. We—all of us in the international community—have to join that majority in Iraq to make sure that the terrorists do not succeed and that democracy prevails. [Hon. Members: "Hear, hear."]
	This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I will have further such meetings later today.

Chris Bryant: Unemployment in the Rhondda is at a historic low of 4.1 per cent. but one in four people is on incapacity benefit. If we are going to get more people off benefits and into work, we need a strong local national health service. Will the Prime Minister guarantee us the funds that we need not only for our new local hospital at Llwynypia but for more new GPs and a stronger primary health care service so that we can put behind us once and for all the Tory legacy of a demoralised and underfunded national health service?

Tony Blair: I am delighted to be able to say to my hon. Friend that not only has unemployment fallen substantially and not merely are there about 1.75 million more jobs in the British economy today, but, as a result of the announcement today for the national health service, there will be 25,000 additional operations. These are, it is true, with private-sector contractors, but they are within the national health service framework and they will be free at the point of use—no patients passport for them. They will allow us to make sure that the record of improving the national health service in this country by a programme of investment and reform is maintained.

Michael Howard: May I associate myself completely with the condolences that the Prime Minister has expressed to the families of those Iraqis who so tragically lost their lives this morning in Basra? As he said, our thoughts also go to the families of the British soldiers who were wounded in those attacks. May I also associate myself with the remainder of his remarks about Iraq and about the need for us to safeguard the position of the majority of the Iraqi people and to see out the commitments that we have entered into notwithstanding the difficulties that we face?
	Mr. Speaker, you can always tell when the Government are in trouble. They call on the hon. Gentleman and they start singing "Help me, Rhondda. Help, help me Rhondda." [Laughter.]
	The Prime Minister recently sent a personal memo to all members of his Cabinet and, as it happens, I have a copy here. It says:
	"Too often . . . change has been initiated in ignorance of the risks and of what might be done to deal with them. In future we need to ensure that risks have been adequately considered before we make policy announcements".
	When he wrote that, what exactly did he have in mind?

Tony Blair: In deciding on this we studied very carefully the record of a previous Minister, and we decided that one thing we really wanted to avoid was being in the position of introducing anything quite as disastrous as the poll tax, opposition to the minimum wage or the social chapter, or a million extra unemployed—in other words, to be as little like him as possible.

Michael Howard: The memo was not sent to me; I am not on the circulation list. It was sent to members of the right hon. Gentleman's Cabinet. It is about his Government, his policies and his failure to make sure that risks are adequately considered before policy announcements are made.
	The Prime Minister was not prepared to tell us what he had in mind, so let me see whether I can help him. When did the Cabinet reverse its policy and decide to hold a referendum on the European constitution?

Tony Blair: We announced our policy on the referendum yesterday. [Interruption.]
	Yes, it is important that we consider carefully any risks in relation to a policy, and we have considered carefully the following risks. We have considered how it is important to make sure that we maintain the best economic record of any Government in many years; we have considered how we keep unemployment down, inflation down and interest rates down and how we keep employment up; we have considered how we maintain the biggest ever investment in health, education, and law and order; and we have considered the very serious risk that all that would not happen if there were a Tory Government.

Michael Howard: The whole country will have seen that once again the Prime Minister has failed to answer a simple, direct question. I am in a helpful mood this afternoon, so I will help him again. We know that the Cabinet was not consulted because the Foreign Secretary told us so last night. From the grandeur of the Foreign Office, he made this authoritative statement:
	"This is a reflection really of, of where we are in terms of, not of spin as some people suggest, but in terms of how we have to live in a much more open society, open culture, and twenty four hour news. Would that it would have been possible to have delayed the announcement until Thursday so it could have been formally discussed in Cabinet but as it turned out it simply wasn't possible".
	That is what the Prime Minister means by Cabinet government: he performs a huge policy U-turn; he leaks it to the newspapers, and then he tells the Cabinet that there is no time left for them to make a decision.
	With or without the Cabinet, let me ask the Prime Minister this question to see to what extent he has followed the advice that he gave to his colleagues in his personal memo and to what extent he has thought the matter through. [Interruption.]

Mr. Speaker: Order. Let the Leader of the Opposition speak.

Michael Howard: If the Prime Minister is still in office when the referendum takes place, and there is a no vote, will he veto the constitution or will he renegotiate it?

Tony Blair: We will be in exactly the same position as, for example, Ireland after its rejection, the first time round, of the Nice treaty. [Hon. Members: "Oh!"] Oh yes, this is an important point. That means that if we were in government, we would sit down and discuss the way forward with other European countries. That is what Ireland did after its rejection of the Nice treaty, and that is what would happen if we were in government.
	Let me put the question back to the right hon. and learned Gentleman. Perhaps he would just confirm that if he were in government his position would be to reject any constitutional treaty whatever. If we were in government, we could, although this would be a serious issue, sit down and plan out the way forward with other countries. However, if the right hon. and learned Gentleman were in office, he would be saying that he was not prepared to accept any constitutional treaty, and that is why he would then be left with a choice of other countries going forward and Britain being in a different relationship with the European Union.

Michael Howard: The Prime Minister has failed to answer a simple and straightforward question. I did not ask him whether he was going to sit down and plan the way forward, but asked a very simple question. Will he veto the treaty in the event of a no vote or will he seek to renegotiate it? Which would it be?

Tony Blair: If there is a no vote, the treaty cannot be ratified on that basis, which is why we, who support the principle of a constitutional treaty, would then have to sit down with the others and work out the way forward. [Interruption.] But that is a completely different position—let the right hon. and learned Gentleman get up and confirm it—from that of a Government who say that they will not accept any constitutional treaty. Perhaps he would confirm that that is his position.

Hon. Members: Answer!

Michael Howard: We are against a constitution for the European Union, because countries have constitutions and nation states make treaties with each other. That is our position. I think that the Prime Minister has confirmed—I will give him a chance to confirm it directly—what we have been saying all along. If this treaty—this constitution—does not proceed as a consequence of a no vote in this country, Britain would remain a full participating member of the European Union. Will he confirm that that is the case?

Tony Blair: If the constitution is rejected in a referendum, of course, the position remains that we then have to work out the way forward with the other countries. Until then, the status quo remains. As for rejecting any constitutional treaty, let me point out to the right hon. and learned Gentleman that this is a treaty, not a constitution absent from a treaty. It is the treaty establishing a constitution for Europe. In other words, it is a treaty agreed in the same way as Maastricht or any other treaty between the European Union members. It is a constitutional treaty. [Interruption.] This is extremely important. When the right hon. and learned Gentleman says that he would reject any constitution, does he mean that he would reject any constitutional treaty?

Michael Howard: I have set out our position with absolute clarity. [Interruption.] If the Prime Minister wants to find out more about our position—

Tony Blair: I do.

Michael Howard: He says that he wants to find out more about our position. Yesterday, he said:
	"let the battle be joined."—[Official Report, 20 April 2004; Vol. 420, c. 157.]
	I cannot wait. I make this challenge to the Prime Minister—[Hon. Members: "Oh!"] As soon as the constitution is agreed, will he take part in a televised debate with me in which we can explore all these issues? Will he accept that challenge? [Interruption.]

Tony Blair: The debate that we will have is here in the House. When it is agreed in this House, we will have a debate in the country. To go back to the heart of the point—[Interruption.]

Mr. Speaker: Order. Let the Prime Minister answer. [Interruption.] Order. I do not want anyone shouting.

Tony Blair: We are having a televised debate now, I rather think, unless we are silent on the television cameras. Just so that we understand his position, will the right hon. and learned Gentleman reject in entirety any constitutional treaty? Let us have the debate. We are on television now, so will he answer yes or no? I shall tell him what I think he is trying to do. He is trying to suggest to one part of his party that he rejects the whole idea of a constitutional treaty, but he is keeping open his freedom of manoeuvre in case he wants to negotiate amendments to the existing treaty. It is an obvious distinction—amendments to the existing treaty or no treaty at all? Which is it? [Interruption.]

Mr. Speaker: Order.

Jackie Lawrence: May I tell the Prime Minister that I am delighted that he has changed his mind and decided to put the issue of the European constitution to the British people? Does he agree that what is good for Europe is also good for Wales? In light of the Richard commission report, if there are any plans to give primary legislative powers to the Welsh Assembly, does he agree that that should be a decision of the Welsh people, not of politicians?

Tony Blair: I thank my hon. Friend for her opening remarks. We will consider the Richard report carefully and we will consider any representations on it carefully. We will make our decisions on it and any consequential policies as a result of that consultation.

Charles Kennedy: May I associate myself and my colleagues with the expression of condolences that the Prime Minister so properly made? Scores of Iraqi civilians have lost their lives as a result of the latest outrage, and reports from the Ministry of Defence confirm that several British troops have been very seriously injured. This is a timely reminder for us all of the escalating violence throughout Iraq as we build towards the 30 June deadline. Given that the United States confirmed last week that it is to deploy a further 20,000 of its forces into Iraq, is the Prime Minister satisfied, as things stand in Basra, that there are sufficient levels of British troops to manage the situation? Has he had requests for more, and does he have any plans to deploy more British troops or equipment into the area?

Tony Blair: We are satisfied that we have sufficient troops in Basra. We do not have plans to increase the number. Of course, we always have to keep that situation under review, but at present the British troops are managing extremely well down there. The attacks today indicate that the terrorists are becoming sufficiently desperate that they are prepared to attack the most defenceless people they can find, simply in order to create maximum chaos. The feedback that we are getting from ordinary Iraqi people in Basra, as one might expect, is intense anger towards those who are killing wholly innocent civilians.

Charles Kennedy: I thank the Prime Minister for that clarification on the British troops. May I ask him a further question, concerning their status? After the 30 June handover, what will be the formal relationship between the British troops and the new Iraqi authority, and between the British troops and the American powers in Iraq? What will be the legal status? Is that likely to be addressed or spelled out in any further United Nations Security Council resolution?

Tony Blair: That may well be the case. There are two separate issues. The first is the new security agreement that we want to draw up with the incoming Iraqi Government. We are talking about that and negotiating with people now. The second issue is what the hierarchy and chain of command will be. Again, we are discussing that. It will be important to make sure in whatever discussions we have that British troops are properly protected—in other words, in doing everything we can to sustain and help the new Iraqi Government, we will have to be careful that the position of British troops and the orders that can be given to them are clear. We will have to help the new Iraqi Administration with such matters.
	Our view at present is that in all likelihood a new United Nations Security Council resolution will allow us to deal with both the political and the security aspects and, I hope, on a reasonably consensual basis. I very much welcome what Japan and South Korea have just announced with regard to their troops. It is extremely important to realise that we have more than 30 coalition countries in Iraq. I believe there is a huge amount of good will in the international community, irrespective of what people thought about the war, to try to help the people of Iraq on their way to the democratic state that it is obvious the majority of them want.

Clive Soley: In view of the continuing and crass invasion of privacy of David and Victoria Beckham, and in view of the judges' concerns about making privacy law on a case by case basis, are there not two rather simple options available to us? One is to make the Press Complaints Commission code of conduct enforceable in law, which would give a toothless body some teeth. The alternative is to enable the editors and owners of newspapers to come before bodies of people here, in the Palace of Westminster, which represents the people, to take questions about their private and public lives.

Tony Blair: I think that what my hon. Friend suggests—perhaps I shall not continue. I say simply that I am sure that this debate will continue. I have no thoughts to offer on it myself, except that I hope that everyone understands that occasionally when people's privacy is invaded in this way, it causes great distress to people, and I do not always think that it is really in the public interest.

Hugo Swire: In the light of yesterday's first report of the Independent Monitoring Commission, which side of this new security screen does the Prime Minister think that Sinn Fein should in future sit?

Tony Blair: We have supported the Independent Monitoring Commission report; after all, we established that body. We will act upon it. Anything in relation to this House is, of course, a matter for this House, but as far as the Government are concerned, we will implement the proposals and recommendations that the IMC makes.

Malcolm Savidge: Will my right hon. Friend welcome the release of Mordechai Vanunu and commit our Government to increasing our efforts to promote a nuclear weapons-free zone throughout the middle east?

Tony Blair: This is obviously an issue, in respect of Mr. Vanunu, on which we have been in discussions and received information over a long period. In respect of a nuclear-free middle east, yes, of course, everyone wants to see that, but what is important is that we recognise that in order to achieve that, Israel is going to have to be sure that it is surrounded by countries that do not wish it ill. That is why it is important that we try to make progress in the middle east peace process.

David Amess: Now that my constituent, Mahjid Nawaz, has been sentenced to five years in prison in Egypt, together with constituents of my hon. Friend the Member for Daventry (Mr. Boswell) and of the hon. Members for East Ham (Mr. Timms) and for West Ham (Mr. Banks), all on the basis of confessions under duress, will the Prime Minister now make a plea for clemency to President Mubarak? As a matter of urgency, will he please meet colleagues to discuss what will eventually be proved to be a very serious miscarriage of justice?

Tony Blair: I do not want to prejudge the outcome of any consideration of those cases. As I have made clear before, we will consider any further action when we have received a transcript of the judge's summation of the verdict. My right hon. Friend the Foreign Secretary says, however, that he is very happy to meet the hon. Gentleman and other hon. Members to discuss the case. I hope that we can find a way forward, while respecting entirely, as I am sure the hon. Gentleman would want to do, the real anxiety of the Egyptian Government and people about acts of terrorism.

Martin Linton: Will my right hon. Friend tell Ariel Sharon that, yes, Israeli withdrawal from Gaza would be a step forward and that, yes, he has every right to expect Palestinian leaders to do everything in their power to stop suicide bombers, but that moderate Palestinian leaders will have no chance if Israel is allowed to continue to create what President Bush called new realities on the ground? It is this constant encroachment on Palestinian land that stokes up the hatred that perpetuates the conflict and is the recruiting sergeant for yet more suicide bombers.

Tony Blair: I understand the point that my hon. Friend makes and the moderate way in which he expresses it. If there is disengagement from Gaza and the west bank, that will be the first removal of settlements for a very long time indeed, and that is important. However, it is also important that we do not create new realities on the ground, but it is for that reason that I believe that the best chance that we have of avoiding that is to make sure that, when the disengagement happens, the Palestinian Authority has the wherewithal in economic, political and security terms, as I said on Monday, to fill the vacuum and ensure that we can move properly back into the road map process, which should lead in the end to what we all want to see—two states: an Israel confident of its security, and a viable Palestinian state.

Elfyn Llwyd: While I fully support the principle of European Union enlargement, may I ask the Prime Minister to comment on the fact that Latvia, which has a population of 2.3 million as compared with Wales's 2.9 million, will have more than twice as many Members of the European Parliament representing it? Furthermore, Malta, whose population is a seventh as large as that of Wales, will have five MEPs, compared with Wales's four. How can he justify this?

Tony Blair: I am not sure that asking for extra MEPs is always the best solution. Latvia stands on its own, while Wales is obviously part of the United Kingdom. There are various geographical and numerical ways to divide up countries, but compared to other countries of a similar size—we consider the matter on a UK basis—the UK is properly and adequately represented in the European Parliament.

Tony Lloyd: On rip-off Britain, is my right hon. Friend aware that the clearing banks are believed to hold some £15 billion in assets from people whose accounts they cannot trace? Given that those banks absorb those assets into their profits, is there not an overwhelming case for a windfall tax to take away the gains from that exercise in corporate greed? Perhaps some of that money should be deployed to prop up people in failed pension schemes such as Allied Steel and Wire, whose futures have been jeopardised by corporate incompetence within the private sector.

Tony Blair: I think that my right hon. Friend will acknowledge that there are two separate issues. First, on unclaimed assets, we support the efforts of the British Bankers Association, the Building Societies Association and National Savings and Investments either to try to reunite owners with their assets or to make sure that that money is used in a different way, although those bodies have fiduciary obligations to their various stakeholders. Secondly, we are actively considering the position of people who, having been forced to contribute to occupational pension schemes, find that all the money that they have invested yields absolutely nothing. We are examining what we can do in such special cases, and, in the context of the current debate on pension protection issues and legislation, I hope that we can come forward with the solution.

Alan Beith: Is the Prime Minister aware of the imminent announcement by the Ministry of Defence that may move most operations conducted from RAF Bulmer in my constituency to Lincolnshire, in which case at least £15 million would have to be spent to replace the facilities, some of which have been recently completed, at RAF Bulmer? Given that the move would not result in a gain in RAF operational effectiveness, will he take an urgent personal look at the questionable figures for potential savings on which the proposed move is based? It flies in the face of regional policy to take £20 million out of Northumberland's economy.

Tony Blair: I appreciate the right hon. Gentleman's concern, because RAF Bulmer is important to his constituency. The Minister of State, Ministry of Defence, wrote to him indicating that it would be £131 million cheaper in terms of net present value to move the units based at Bulmer. I know that that point is disputed, but the House will understand that the Ministry of Defence must constantly balance hon. Members' desires to keep units in their own constituencies with the need to keep military capability and military spending under review and to make sure that funds are used efficiently and effectively. I am happy to examine the matter, but I do so without a commitment or guarantee.

Vera Baird: From September, children of 16 will, for the first time, be entitled to cash payments—education maintenance allowances—to stay on at school. Historically, we have disincentivised them, because, of all the options open to them, school is the only one that does not pay. The scheme is yet another excellent idea, and it would undoubtedly come under the hammer if the Opposition got their hands on it. Youth skill levels are currently poor, and we have the lowest staying on rates in Europe. Does the Prime Minister believe that the measure will make a real difference?

Tony Blair: The measure will make a real difference, and the pilots indicate that more young people will stay on at school as a result of the allowance. Labour Members certainly think that it is important to encourage young people to stay on and study after the age of 16, and the measure must be considered alongside the substantial extra investment in education. The scheme has been widened to include the whole of the 16 to 19-year-old bracket, and some 300,000 young people will benefit. We must also ensure that vocational skills increase by expanding the vocational skills route, which is part of making sure that we get the educated work force that this country needs.

William Cash: Will the Prime Minister accept, in relation to his earlier remarks with regard to the nature of the treaty and constitution, that in fact, under the proposed constitution, all the existing treaties will be revoked and reapplied with the existing acquis communautaire under the primacy of a new constitution? Will he therefore accept that that, as the House of Lords has already said in a report, is a fundamental change?

Tony Blair: It is a constitutional treaty, and it is therefore a treaty in the same way that the other treaties are treaties. The hon. Gentleman is right, of course, in saying that many of the provisions in the earlier treaties are bound into this one. That is absolutely right—a significant part of it simply replicates the existing treaty basis. That is the position that I was putting to the right hon. and learned Member for Folkestone and Hythe (Mr. Howard). The hon. Gentleman of course has a very clear position on this—he wants to change fundamentally the existing nature of the relationship between Britain and the European Union. That is right, is it not? He certainly does not want any constitutional treaty at all.

William Cash: indicated assent.

Tony Blair: The question is whether his right hon. and learned Friend is in the same position. What is interesting about today is that now we are actually debating the detail.

Fireworks (Amendment)

George Howarth: I beg to move,
	That leave be given to bring in a Bill to amend the Fireworks Act 2003.
	Last autumn, problems were caused on Merseyside and elsewhere, including in my constituency, by a large number of incidents involving imported fireworks, many of which came from China. In particular, fireworks were used to attack fire crews, buses carrying people, and private property. There were even attacks on pillar boxes, and on more than one occasion the lid was blown off—one can imagine the force required, given that they are made of cast iron. Some attacks terrorised elderly people to the extent that they were afraid to go out of their houses during that period. Perhaps most worryingly of all, there is evidence that the materials from those imported fireworks were being used by people involved in organised crime to further the interests of the so-called businesses that they engage in. Clearly, there is a serious problem.
	Before I go any further, I should say that I am indebted to the Merseyside police, the Merseyside fire and rescue service, Mr. John Woodhead, who is chairman of the British Fireworks Association, Knowsley borough council and many others for the advice and assistance that they have given me in preparing the Bill—although I should say that any faults are mine alone. I am also in consultation with the Under-Secretary of State for Trade and Industry, my hon. Friend the Member for Bradford, South (Mr. Sutcliffe), and his Department about the detail of the Bill, and I hope that at some point he will feel able to support me in my endeavours.
	The purpose of the Bill, which borrows heavily from the thinking of Merseyside police and the Merseyside fire and rescue service, is to introduce proper and workable controls to regulate the importation of fireworks from abroad. The Bill seeks to amend the excellent Bill that my hon. Friend the Member for Hamilton, South (Mr. Tynan) introduced last year by requiring importers of fireworks to notify the proper authorities—in most cases, Customs and Excise and the trading standards authorities—of the impending arrival of consignments. It will require them to demonstrate that those consignments will be taken to and opened up only on licensed storage sites and to give prior notice to the appropriate authority about where the fireworks will be sold. The measure also provides that fireworks must be supplied only to those with adequate registered storage facilities. The provisions will enable the authorities to get a proper grip on this growing and worrying problem.
	I hoped that the right hon. Member for Bromley and Chislehurst (Mr. Forth) would be present because I intended to direct my next observations at him. I accept that the ten-minute rule procedure does not allow time for proper scrutiny of Bills. I have therefore undertaken to make arrangements for informal pre-legislative scrutiny during three sittings in the second week of May. Any hon. Member, member of the public or representative of any organisation who wishes to give evidence or make representations can do so to the committee that I shall set up. It is an informal procedure and I give a further undertaking that serious note will be taken of any representations. If appropriate, I am more than willing to make proper amendments to the Bill.
	I believe that it is important to apply pre-legislative scrutiny not only to Government Bills—that increasingly happens—but to private Members' measures. It gives us an opportunity to ensure that a measure is properly and fully considered.
	The Bill is necessary to protect the public from the irresponsible and dangerous misuse of highly explosive materials. The term "fireworks" understates them. The measure is sensible and timely, and I hope that it will acquire the necessary support for it to be enacted.
	Question put and agreed to.
	Bill ordered to be brought in by Mr. George Howarth, Janet Anderson, Mr. Joe Benton, Sir Sydney Chapman, Mrs. Claire Curtis-Thomas, Mr. Elfyn Llwyd, Mr. Alan Meale, Dr. Lewis Moonie, Mr. Edward O'Hara, Dr. John Pugh, Mr. Bill Tynan and Sir Nicholas Winterton.

Fireworks (Amendment)

Mr. George Howarth accordingly presented a Bill to amend the Fireworks Act 2003: And the same was read the First time; and ordered to be read a Second time on Friday 18 June, and to be printed [Bill 91].

Opposition Day
	 — 
	[9th Allotted Day]

Doctors' Hours

Mr. Speaker: We now come to the first debate on the Opposition motions. I inform hon. Members that there is a 12-minute limit on Back-Bench Members' speeches and that I have selected the amendment in the name of the Prime Minister.

Andrew Lansley: I beg to move,
	That this House notes the forthcoming implementation of the European Working Time Directive (EWTD) in relation to junior hospital doctors; further notes the changes to General Practitioner out-of-hours services following the implementation of the new GP contract; is concerned by the British Medical Association's estimate that, from August 2004, the EWTD requirements could lose the NHS the equivalent of 3,700 junior doctors; is alarmed by the failure of Ministers to quantify adequately the likely demands of the EWTD in medical manpower and money costs; is further alarmed by the Government's complacency over the 'SIMAP/Jaeger' judgements made by the European Court of Justice and the disproportionate impact they will have on smaller hospitals; notes that cost estimates for GP out-of-hours cover are rising yet the extent of cover is likely to decline; deplores the failure by Ministers to anticipate the impact that the new GP contract will have on community hospitals and notes with alarm that several are already under threat; and wishes to see the implementation of out-of-hours cover in a form that maintains a GP-led service in which the high standards of care and accessibility traditionally associated with primary care in England are maintained.
	We would have had an opportunity to discuss the subject before the recess, on the eighth allotted day, but the competition among Departments to register incompetence meant that, on that occasion, the Home Office outdid the Department of Health. However, we have moved on to the Department of Health. While the Government are obsessed with Europe, the Opposition are putting the national health service at the forefront of our concerns.
	Today's motion addresses two issues: the impact of the further implementation of the European working time directive, specifically in relation to junior doctors; and the implementation of the out-of-hours services component of the new GP contract. Those two distinct issues are obviously related, and they disclose common concerns. Although there have been positive intentions throughout, the measures are having perverse practical effects, and even when such effects have been identified, Ministers have failed to act to clarify or, if necessary, amend the proposals. Where it has not been possible or appropriate to amend them, Ministers have failed to give the necessary support for the service to implement the changes, in the face of mounting evidence of the problems and associated costs. Not only are the Government showing a lack of support; they are showing a degree of complacency about the impact of the changes.
	So, the charge is one of a lack of competence. It is not one of a lack of positive intentions, but, in practice, the Government are not delivering on what they have said they will deliver on. That is the problem with this Government. In the light of what my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard) was saying at Prime Minister's Question Time earlier, it is clear that the Government did not assess the risks involved and respond to them before they introduced and sought to implement these policies.

Henry Bellingham: Does my hon. Friend agree that, while the Government have tried in regard to this issue, they have had one hand tied behind their back, because when Ministers have gone to the European Parliament to seek the support of socialist MEPs on this issue, they have received absolutely none—from their own MEPs in Brussels?

Andrew Lansley: My hon. Friend is right, and I pay tribute to the work that he has done in drawing attention to the impact of the working time directive.
	On 8 April, the House of Lords European Union Committee set out its conclusions on the Commission's review. The Committee reiterated its conclusion that the voluntary individual opt-out should be retained. That is important not only for business interests, which my hon. Friend the Member for North-West Norfolk (Mr. Bellingham) represents so splendidly, but for the NHS. Ministers accept that it is important for the NHS that the voluntary opt-out be retained, but on 3 September last year, the Labour MEPs in the European Parliament turned out and voted to abolish the UK's voluntary opt-out. On 11 February this year, the Labour MEPs voted against that opt-out and against what appeared to be the stated policy of this Government.
	However, when my hon. Friend, the shadow Secretary of State for Trade and Industry challenged his opposite number on this matter, she simply would not say that she was going to deal with those Labour MEPs, or that we could feel confident that they would support the UK interest in any future changes to be made to the working time directive. Those MEPs do not support the UK interest, and voters will need to know that on 10 June this year. I am grateful to my hon. Friend for allowing me to make that point.
	Before I address the issue of the working time directive, I want to make it clear that we are not questioning the principle—far from it; we support it—of reducing junior doctors' hours to a level that is consistent with patient safety and the best interests of the doctors themselves. I shall not reiterate the history of this issue; it is well known to some hon. Members, especially to those Conservative Members who have experience of introducing the new deal on doctors' hours. I suspect that the introduction of reduced hours for junior doctors would be achieved in the best interest of the health service without the intervention of the European working time directive. However, we have to deal with the directive, and it is causing inflexibilities.
	The agreement was reached on junior doctors in May 2000. In October 2000, there was the so-called SIMAP judgment relating to primary care doctors in Spain, the effect of which was to define the nature of working time when one is resident and on call, and, in effect, to treat all the time that one is on the premises and available for work as working time, regardless of whether one is working or asleep. I know that it was not the Government's intention to treat the time that one is asleep as working time, but that is the practical effect of that judgment. It was April 2002 before the Department invited pilot studies from around the country to see how the implementation of the working time directive could be achieved, and July 2003 before Governments collectively, or a number of member state Governments, approached the Commission to try to secure changes in consequence of the SIMAP judgment and its adverse effects on health care in particular.
	In October 2003, the so-called Jaeger case made it even more clear that all the time during which one was resident and on call would be treated as working time. In particular, it added the further inflexibility and adverse effect that compensatory rest for the time worked on call, including while non-resident and on call, would need to be compensated for immediately—in effect, before the following period of work. To give my hon. Friends a sense of what that means in practice, an NHS doctor—a senior registrar or consultant—who is non-resident and on call, and who is called up several times during the night, either to go to the hospital or to take consultations over the telephone about patients, must be compensated with additional rest before commencing their next period of work. Of course, the chances are that before they commence their clinic or operating list the following morning, they will have to have compensatory rest. Evidently, as Ministers understand, problems will ensue for hospitals from having arbitrary and, in effect, overnight changes in their operating lists and clinic rotas.

Hilton Dawson: The hon. Gentleman is making some interesting and important points. I apologise for missing the first few moments of his speech, and I wonder whether he has already put his remarks in the context of the Government's unprecedented 33 per cent. improvement in investment in primary care. Will he move on to that and establish the proper context for this debate eventually?

Andrew Lansley: I am grateful for the hon. Gentleman's contribution. I have not talked about primary care yet, and I will do so later.
	On investment in hospital services, the hon. Gentleman raises an important point, because all the issues that I am discussing have implications—not only the working time directive but "Agenda for Change" and the implementation of the consultants contract, which I shall mention briefly later. The combination of those changes not only imposes significant financial and managerial challenges for the NHS, but those financial challenges may obviate—this will worry Labour Back Benchers—the resources that the Government so trumpet in terms of growth in activity in the NHS. I have spoken to a number of chief executives of a range of hospital trusts, whom I have asked how much more it will cost them in this financial year, 2004–05, to deliver the same activity as in the preceding financial year. The answers vary, but the average is between 8 and 9 per cent. extra. In the context of what the hon. Gentleman asserts are unprecedented increases in the amount of money available—we agree absolutely that more money must be available for the NHS—that shows the importance of managing and introducing changes in a way that delivers growth in activity and investment with reform. That is what the Prime Minister says—I heard him say it again at Prime Minister's questions—but he spends the money and does not deliver the reform.

Hilton Dawson: Is it not also about delivering improvements in the quality of services and ensuring that primary care trusts manage their services much more effectively in the future?

Andrew Lansley: I have no disagreement with the hon. Gentleman, but I think that as we proceed it will become clear that managing the system depends more on enabling hospitals to make changes effectively than on relying on the Government, who have done abjectly little to help hospitals implement the working time directive in a timely fashion.

Patrick McLoughlin: Will my hon. Friend confirm that when he spoke of an 8 or 9 per cent. increase, he was referring only to the implications of the directive and not to the implications for community hospitals of the GPs' contract, which is likely to involve a further huge expenditure?

Andrew Lansley: I was talking about the increase in costs for acute trusts. As my hon. Friend will know from his constituency experience—and from his constituent Dr. Holden, who speaks for the British Medical Association on these matters—if GPs were compensated fully for their work in community hospitals and for the quality of that work, there would be a substantial additional cost. The Government do not propose to meet that cost, but it raises serious issues for community hospitals.

Howard Stoate: Does the hon. Gentleman think that consultants who are called out during the night and whose sleep is therefore very disturbed should have a break afterwards? Would he expect an airline pilot who has been asked to do an extra shift and fly to America to work his normal shift in the morning? Would he expect a pilot who has just flown for eight hours to fly for a further eight hours, or would he prefer that pilot to have a rest after flying across the Atlantic in the middle of the night before flying back the next morning?

Andrew Lansley: I think we should work with consultants on a flexible, agreed and negotiated basis, as has been happening increasingly. Yes, compensatory rest is desirable, but it is certainly not desirable for it to be granted as a legal requirement before the next period of work, as that would result directly in adverse consequences for operating lists and for clinics. There may be a case for it in some circumstances, but it will depend on the extent of the interruption during the night.
	The whole structure in the NHS is being driven not by flexible local negotiations, as it should be, but on the basis of European Court of Justice judgments about the circumstances of an individual German doctor, which do not strike me as relevant to the way in which we manage the health service.

Howard Stoate: So the hon. Gentleman is saying that if a consultant surgeon has to operate in the middle of the night it is okay for him to proceed with his morning operating session, although it would certainly not be okay for an airline pilot who has flown for an extra session to fly a plane the following morning. I would not want to be the patient of a doctor who had been out in the middle of the night and was expected to carry on as normal without a proper rest period.

Andrew Lansley: I respect the hon. Gentleman's professional expertise, but he has moved the goalposts. I was talking about non-resident on-call doctors. It is very unlikely that night surgery would not have been allowed for in rotas relating to clinics or operating lists for the following day, as the hon. Gentleman probably knows from his experience.
	We may all agree that the working time directive should not be imposed on us. The Government at least seem to agree with that, but what have they done about it? In a recent response to the House of Lords European Union Committee, the BMA commented that the implementation of the directive could involve the equivalent of 3,700 junior doctors from August 2004, and that the implementation of the 48-hour limit in 2009 could involve the equivalent of between 4,300 and 9,900. In its evidence to the Committee, the Royal College of Physicians said:
	"in its present shape and form, compliance will have serious long-term effects for continuity of care, patient safety, and the education and training of doctors."
	The BMA said:
	"The BMA considers that the requirement made in the Jaeger judgement that compensatory rest should be taken before returning to work has huge service and workforce planning implications and is likely to be unworkable and in most cases unnecessary."
	In January this year—nearly four years after the agreement on junior doctors, more than three years after the SIMAP judgment and months after the Jaeger judgment—the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), told the Royal College of Surgeons:
	"Complying with the Working Time Directive need be neither costly nor a burden."
	That is odd, given that the Minister told the European Standing Committee on 24 March:
	"We indicated at the end of last year a worst-case scenario of between 6,000 and 12,000 additional doctors"
	and
	"The cost in relation to doctors would be between £380 million and £780 million."—[Official Report, European Standing Committee C, 24 March 2004; c. 15–19.]
	We must see that alongside the Government's allocation of £46 million over three years for specific action to help implement the directive.
	I recall the Minister sending the NHS this message in January: "Do not worry, it is not a problem, you can do it, it will not cost much—just get on and do it." At the same time, Ministers knew that according to the worst-case scenario thousands more doctors and hundreds of millions of pounds would be required. In evidence to the Commission, they said that the implementation of the Jaeger judgment would cost tens of millions. They knew there was a problem, but they did not tell the NHS what they proposed to do about it.
	In its evidence to the House of Lords European Union Committee, the BMA said of the pilot studies:
	"proposals for these pilots were not initiated until April 2002, about four years after the implementation of the EWTD and less than 2 years before the extension of the Directive to junior doctors. The final results . . . are unlikely to be in time to aid the implementation of the EWTD for junior doctors."
	In fact, I suspect that the final evaluations will come in around November.
	That is fine, is it not? If hospital consultant posts are to be changed in time for implementation in August 2004, design for that change should really have started in August 2003. If junior doctor rotas are to be changed and additional junior doctors recruited, the process should already have started: no less than a six-month lead time is required. We are already in the period during which hospitals should have taken action to achieve compliance with the directive.
	The medical profession has done more than Ministers and the Department in initiating the "hospital at night" programme, which the Minister will no doubt describe to us. The BMA, to its credit, has been pushing for years to secure action and awareness. On 25 February, Jim Johnson, its chairman, said:
	"it seems that the government has only just grasped the potential impact of these changes. Too little has been done too late."
	That, I am afraid, is the sorry story of the working time directive.

Mark Francois: My hon. Friend referred to the debate on 24 March in the European Standing Committee. I was present and, as the Minister will recall, he and I crossed swords quite actively over this issue. He admitted that it did not apply solely to doctors, but would require additional staff in other categories. As can be seen in column 13 of the Hansard report, he acknowledged that extra nurses in a number of categories would be needed. However, the £780 million figure that he gave the Committee was only the NHS estimate of the additional cost for doctors. When other staff are included, the estimate will be even greater. The Minister promised to provide the figure on the day, but failed to do so. Does my hon. Friend agree that it would be helpful if the Minister honoured that commitment today and gave us the total figure?

Andrew Lansley: Perhaps the Minister will take up that question. The estimates have indeed related to doctors. My personal view is that the scope of "Agenda for Change" should enable the nursing profession to be compliant with the working time directive without substantial additional costs. My argument rests on the implications for doctors' hours and the costs to the NHS.

John Hutton: I am interested in what the hon. Gentleman said about "Agenda for Change", which he prayed in aid in relation to supporting the NHS in meeting our obligations under the working time directive—but is not his party opposed to "Agenda for Change"? Did not the hon. Member for West Suffolk (Mr. Spring) make it clear when he was appointed as shadow spokesman that he was against national pay bargaining for the NHS?

Andrew Lansley: No, he did not say that. He is in favour of NHS trusts and foundation trusts having the freedom to respond locally—through pay, if necessary, as well as other conditions of service—to their particular needs. Is it the Minister's view that hospitals should not have that freedom? If so, let him say so. I said to him in the Standing Committee that considered the Health and Social Care Bill last year that we support "Agenda for Change" and the ability of nurses, in particular, to be supported in extending their role and to have their work reflected in their rewards, and it is entirely appropriate for that to be negotiated. Review bodies provide a national pay framework, and it is in the interest of NHS trusts that they should do so, but that is a framework, not a straitjacket. Is the Minister saying that the Government want to put the NHS in a national pay straitjacket?

John Hutton: The hon. Gentleman knows, because he does his homework, that "Agenda for Change" incorporates an element of flexibility in meeting local pay terms. That has always been the case. The Government have always supported "Agenda for Change". The issue is whether the Opposition do. The hon. Member for West Suffolk made it clear in his first interview as shadow public services spokesman that the Conservative Opposition are against "Agenda for Change" precisely because it is a national pay agreement and he would prefer to revert to local trust contracts. If the hon. Gentleman is saying that this is one further aspect of his health policy reforms that he has abandoned, we would welcome that news.

Andrew Lansley: I am not having any of that. We have made it clear throughout that we favour hospitals having the freedom to manage themselves and respond to their particular needs. If the Minister is against that, let us put that on the record. I am not having the suggestion that by allowing that freedom we necessarily abandon either pay review bodies or "Agenda for Change". There is nothing that my hon. Friend or I have said that would suggest that an incoming Conservative Government—before too long, we hope—will abandon or reverse "Agenda for Change", but it must be regarded as a framework rather than a straitjacket.
	There are practical implications. Managers at a district general hospital told my hon. Friend the Member for Westbury (Dr. Murrison)—he may refer to this in more detail later—that, being in deficit, they cannot afford to pay staff to be treated as working while they are sleeping, so they have to move to full shift working, and to some extent from doctors to nurse practitioners. That may be entirely acceptable, but if staff on full shifts are not then fully employed, the activity needs to be increased to ensure that they are.
	The hospital managers said:
	"this may require the closure of some units and the transfer of work to units with spare capacity. This will affect many of the medical low volume specialties where there is a requirement to have residential specialist staff".
	Hospital at night can achieve many things, but there cannot necessarily be cross-cover, for example between non-paediatric and paediatric staff. Cross-cover is not possible on obstetrics, if people are not obstetric-trained and experienced, or on anaesthetics. Some rotas simply have to be staffed with those specialists. If the hospital cannot scale up from the five doctors that it has now to the arguably nine or 10 that will be required for a full shift a few years hence, those units will close.

Andrew Turner: rose—

Andrew Lansley: I see that someone who may have direct experience of this in his constituency would like to intervene.

Andrew Turner: There are some hospitals that cannot attract greater volume because the distances or the means of travel are too difficult, but for the very same reason cannot be closed. How are they supposed to survive within the same budget and yet meet "Agenda for Change"?

Andrew Lansley: That is an important point. The directive will bear harshly on some specialties and in some remote areas. The Isle of Wight has special problems that will have to be managed.
	Our prospective parliamentary candidate in Southport, Mark Bigley, reports:
	"The Hospital Trust says they cannot run A&E services at Southport due to the impact of the EWTD on junior doctors' hours."
	There may be a complementarity between what local people want there and what my hon. Friend wants on the Isle of Wight. They know that centres of excellence and major specialties may have to be concentrated—perhaps in Southampton, in my hon. Friend's case—but they want access to stabilisation and treatment more locally and accessibly, so that large numbers of people do not have to be referred a great distance away for routine treatment.
	My colleague in Enfield, North referred me to the health hospitals review document of Barnet and Chase Farm hospitals, which says:
	"Neither the doctors nor the funding is available for the hospitals simply to 'grow' their teams out of this problem."
	That may bear on maternity, for example, or obstetrics.
	I do not know the precise circumstances, because it is in Scotland, but even today The Herald reports:
	"New rules cutting the number of hours worked by junior doctors and consultants, which make staffing multiple maternity hospitals more difficult are threatening units across Scotland."

Stephen McCabe: Before the hon. Gentleman goes through the complete list of prospective Conservative parliamentary candidates—at least some of them know where the constituency is, which is not the case in Hall Green, as I noticed from a recent visit—can he tell us how he will square these demands for additional funding with the fact that his party voted against the 1 per cent. national insurance increase? How can he reconcile that? It is a fundamental question.

Andrew Lansley: With respect, it is not fundamental to the implementation of the working time directive. We have committed ourselves to the resources for the NHS, to support not only reform but the additional transitional costs, which the Government are clearly not doing, when one compares the costs that they anticipate for the working time directive with the £46 million that the Minister has promised.
	When we had a modest one-and-a-half hour debate on GP contracts—one of the major changes in the NHS—on the back of the Health and Social Care Bill last July, the Minister made a statement in response to my hon. Friend the Member for South Staffordshire (Sir Patrick Cormack), who told me that he wished to be here today but had to attend an important meeting with a constituent and so sends his apologies. The Minister said to my hon. Friend:
	"I know from my work as a constituency MP that our constituents place a high premium on around-the-clock access to a GP, 24 hours a day, seven days a week. It is a defining characteristic of our primary care services."—[Official Report, 8 July 2003; Vol. 408, c. 1050.]
	That is the promise from this Government, but what is the reality? A shift to emergency nurse practitioners and paramedics. Perhaps that is acceptable, because it is appropriate care. A shift to NHS Direct's handling the calls. Perhaps that is fine too, although it turns out that the Minister of State, the hon. Member for Doncaster, Central (Ms Winterton) said in a reply to me that she had no estimate of how many primary care trusts were going to ask NHS Direct to handle their calls for out-of-hours services, so quite how NHS Direct will be able to staff up to provide that service, I do not know. However, as a consequence of a shift to NHS Direct's handling the calls, do we shift from risk management by GPs to risk management by the NHS Direct clinical assessment software? That is not the same GP service that people thought that they had before.
	Everywhere that I have gone around the country, people have told me that they expect that their GP out-of-hours service will be run with fewer GPs. In one place that I visited recently, I was told that roughly speaking, the point would come where a GP sat in a centre and never really went out on call because there would not be enough GPs available in the service to enable them to travel around the country; they would have to sit in one place. Will this be a GP-led service? That is the issue.
	What do GPs themselves say? In January, the health journal Pulse surveyed 1,168—

John Hutton: That is where the Opposition get this from.

Andrew Lansley: I am not aware of any evidence that the Government have asked GPs what their concerns are, or responded to them. We are at least doing that.

John Hutton: They voted for this.

Andrew Lansley: Yes, they voted for it. We have no dispute with the GP contract in principle: it is a good framework. Quality and outcomes in replacement of item of service is a good framework, but we are talking today about the implications for and the management of the out-of-hours service, and it would be helpful if the Minister would focus on that, rather than trying to divert attention from the issue, which is all that the Government have done throughout the debate.
	What did Pulse say? Of 1,168 GPs, 83 per cent. intended to opt out, and the actual figure will probably be higher. Although 51 per cent. said that they would work out-of-hours shifts, only 12 per cent. anticipated working significantly more than the amount necessary to recover the money that they would lose by opting out. That implies a substantial reduction in GP availability for out-of-hours services. What did the GPs—not the Conservative Opposition—think would be the consequence? Some 92 per cent. said that more patients would be seen in accident and emergency. Accident and emergency departments in many places are already seeing up to double-digit percentage increases in admittances. Some 90 per cent. of GPs expected their Monday morning work load to climb. Some 72 per cent. said that patients would get more inappropriate advice and poorer quality care, and 62 per cent. thought that patients would be less safe. That is being said not by me, but by GPs themselves.

Sandra Gidley: The hon. Gentleman is raising an important subject, but is he not being a little simplistic? At the moment, many GPs choose to contract out of the system, and out-of-hours care is frequently provided by providers such as Primecare. That has already caused huge problems in various parts of the country. Is it not a little simplistic just to blame the changes on the GP contract, when many GPs are not taking those responsibilities on themselves at the moment?

Andrew Lansley: I plead guilty to the charge of simplicity, and it is kind of the hon. Lady to levy it at me. I am normally accused of talking too much about the detail—the Minister would accuse me of that. However, I do not share the hon. Lady's sentiment. GP co-ops and GP-led services are delivering a good service in many places across the country—I think in the balance of them. In my view, it would be better for us and for the Government if they made it clear that, although the individual obligation on GPs to provide out-of-hours cover to their own list was removed, there was none the less the expectation, in the context of the GP contract as a whole, that co-operative systems led by GPs would be developed. Letting GPs design the local out-of-hours services—

Howard Stoate: rose—

Andrew Lansley: I have given way to the hon. Gentleman twice, so I shall now try to conclude because there are other hon. Members who are clearly itching to contribute to our discussions.
	We have a contract, much of which is good, but the Government have not focused on the problems. We are moving away from precisely what the Government promised. The Minister promised 24-hour access to a GP service, but what we will have will not necessarily be a GP service, and will perhaps not even be GP led or GP managed in effect. The perverse results go on, including the cancellation of Saturday surgeries. I do not know what proportion of surgeries that involves, but one PCT told me that even before the start of the contract, 60 per cent. of Saturday morning services had gone. I suspect that the figure across the country is at least that.
	The Government have not commissioned GPs in community hospitals. My hon. Friends will know that many GPs look after beds in community hospitals and provide services to minor injuries units there. They are integral to the continuation of those local, accessible services. The Government publish documents telling us how important community hospitals are, which we know from personal experience. They provide step-up care for patients and step-down care from hospitals, and deal with the problems of delayed transfer of care from hospitals. However, the Government have not put in place a framework to enable PCTs to carry out that commissioning. I spoke to one chief executive of a PCT, who had better be nameless—for the sake of clarity, this was not the PCT in my constituency—who said that community hospitals were something that the Government had put in a box marked "too difficult".
	That is the story of the working time directive and the GP out-of-hours service. The Government have failed to act on the working time directive, and if they do not act now, they might fail to deal with the implementation problems of the consultants' contract. Will the Minister ensure that things that could be done, such as commencing negotiations immediately on the staff grade and associate specialists, will be done?
	The Government failed to prepare for the out-of-hours changes. The Audit Commission has demonstrated how many complex changes are occurring at once and how important good financial management is, but that also requires leadership from the Department and Ministers. The costs escalate. It seems that the GP out-of-hours service will cost nearly double what it has cost until now, but most PCTs will receive only 60 or 70 per cent. of the additional cost, and many cannot afford the rest. They are therefore having to make cost-driven changes to the GP out-of-hours service.
	Complacency is written through the Government amendment like sugar writing through a stick of rock. No reference is made to the new deal, or to the fact that we are reducing junior doctors' hours. There is no reference to the impossibility of compliance by August 2004 or the need for urgent interim action, as recommended by the House of Lords. We need urgent action not only by the European Commission, but by the Government to decide what will happen in August 2004 if the Commission has not delivered a satisfactory solution to the SIMAP and Jaeger problems.
	There is no reference in the Government amendment to the implications for smaller hospitals or for sub-specialties. It contains no reference to GPs' concerns about out-of-hours services, no reference to the loss of Saturday morning surgeries, no reference to the threat to community hospitals and no reference to the issues that the Government have found too difficult. They do not want to deal with the issues that are too difficult; they have handed them out to the service without the resources or support to make things happen. If the Government find this matter all too difficult, we have an answer: step aside and let us deal with it.

John Hutton: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"welcomes the overall aims of the European Working Time Directive (EWTD) to ensure humane working hours for doctors in training; further welcomes the Government's lobbying of the European Commission and other EU Member States which has resulted in the Commission's giving assurances that they will bring forward legislative proposals on the EWTD before the summer; notes the dramatic reduction in the hours of doctors in training which means that 95 per cent. of them now work for 56 hours or fewer; congratulates the Government on the increases in workforce numbers and medical school places, which mean there are now almost 7,000 more consultants and 55,000 more nurses than there were in 1997, and that 6,030 students entered medical school in England in autumn 2003; welcomes the work being done in the National Health Service in implementing new ways of working that contribute to modernising and improving services and meeting the obligations of the Directive; and joins the Chairman of the BMA's General Practitioners Committee in welcoming the new GP contract as being 'better for patients and better for everyone working in general practice' and notes that it will allow primary care trusts to offer patients a safe, high quality service, with care delivered by the most appropriate professional, through better use of more joined-up services."
	The hon. Member for South Cambridgeshire (Mr. Lansley) has brought to the House's attention his hon. Friends' concerns about the new contract for GPs, the provision of out-of-hours services and the implementation of the European working time directive. He is perfectly entitled to do that, and I give him credit for the way in which he presented his case. However, he has not set out the one thing that we are entitled to expect from him: his alternative. For example, are the Conservatives in favour of the new contractual arrangements covering the provision of out-of-hours services, yes or no? Those have been supported by 80 per cent. of GPs. Would they have agreed to the changes themselves? Sadly, no one is any the wiser. Do they believe that junior doctors should be covered by the provisions of the European working time directive? Will they commit themselves to match the expansion in the number of doctors, nurses and allied health professionals that the NHS is seeking to recruit over the next four years? It seems not.
	On all those questions, the hon. Member for South Cambridgeshire had nothing to contribute, except for his usual diet of doom and gloom, mixed with a new element and exciting addition to the menu—sanctimonious hot air. The House should have heard from him this afternoon answers to all the basic questions I mentioned, but predictably, all we had was his familiar recycled rhetoric—and pretty indigestible stuff it was, too.
	First, let me deal with his concerns about the European working time directive, which is where he started his detailed remarks. The Government strongly support the need for employees to enjoy fair standards of employment protection, whether in the NHS or anywhere else. In respect of the NHS, an obvious importance should be attached to ensuring that front-line staff work reasonable hours and have proper rest periods. The working time directive is a crucial part of that framework. It establishes minimum entitlements for employees as well as providing for the right of individuals to choose to work longer hours if they want to. I therefore believe that it helps to support the important objective of British competitiveness, as well as the employment rights of British workers.

Stephen Dorrell: Every Member in the House would agree that doctors working in the NHS must be employed on terms that ensure high-quality care to patients, and that their hours of work are part of that equation. That is uncontroversial. The question for the Minister is whether his task, as the representative of the doctors' employer, has been made easier or more difficult by the introduction of the European working time directive as interpreted through the two judgments. As an employer seeking to deliver agreed objectives, is his task easier or more difficult?

John Hutton: It has been made immeasurably more difficult. I have acknowledged that on previous occasions, as the right hon. Gentleman, who reads all my press releases on the Department's website, would confirm. There is nothing new about that. I shall develop my concerns about the SIMAP/Jaeger judgments in a few moments, but it is obvious for anyone who observes these issues that the European Court's interpretations of the definition of working time—and, crucially, in the Jaeger case, of when compensatory rest should be taken—have made matters immeasurably worse. In fact, on the Jaeger case, the UK Government made representations to the European Court, arguing for precisely the opposite interpretation of the directive. Sadly, we lost that argument in the Court, but I do not believe that we have lost it in the wider court of opinion among the Council of Ministers and the Commission—a point to which I shall return.
	It is clear not only from today's debate but from all previous debates on these matters that there is a disagreement between Government and Opposition about the terms of the directive and whether we should provide for these rights in law at all. The hon. Member for South Cambridgeshire has made it clear that he believes that we should not. For the sake of making progress on the substantive issues, I shall not develop arguments about that particular issue today, although it is worth pointing out that all the negotiations surrounding the wording of the directive took place under the leadership—if that is the right word—of the previous Conservative Administration.
	On at least one point, however, there is likely to be general agreement across the House and outside it—that implementing the European working time directive in the light of recent decisions of the European Court of Justice presents a very considerable challenge to the NHS and particularly to specialties such as paediatrics and obstetrics. The NHS is taking action at a number of different levels to respond to that challenge. In the course of my remarks, I want to set out how we are attempting to achieve that in more detail, but it might be helpful if I first set out the general principles that we have been following.
	First, our priority must be to implement the directive in a way that maintains both the quality and accessibility of NHS services. Our response will not be based on the assumption that we will have to restrict access to vital health care services, which would be contrary to the wider public interest, and disproportionate. That is why we have ruled out that approach.
	We are committed instead to maintaining and improving local access to services and have published guidance aimed at ensuring that that principle is fully reflected in local NHS decision making. The focus of the guidance is on redesigning services—not relocating them—around the needs of local populations. The NHS, in implementing the directive, needs fully to develop the contributions of different hospitals and primary, intermediate and social care providers as part of a sensible and integrated approach.
	Secondly, in implementing the directive, we must not substitute tired consultants for tired junior doctors because that would benefit neither doctors nor patients. Instead, we need to look carefully, as we have, at the contribution that the whole NHS work force can make in helping to reduce the hours that junior doctors currently work. The EWTD is not therefore just about the hours that doctors work, but goes much wider and deeper.
	Thirdly, as we make progress in implementing the directive—and we are—we need to maintain and, where possible, improve the quality of junior doctor training, helping to ensure that the doctors of the future are as well equipped as possible to meet the challenges of a lifetime of professional practice. So in meeting the requirements of the directive—clearly the obligation of the NHS—we must be careful not to compromise on the standards of medical education and training. That, too, would not be in the long-term interests of doctors or patients.
	In all those areas, work is already well advanced and I will spell out the progress that has been made. I reject the Opposition's suggestion that little or nothing has been done. They would say that, but the opposite is true. The Department has worked closely with the Academy of the Medical Royal Colleges, individual royal colleges, the BMA—whom I met again this morning to discuss the issue—the NHS Confederation and other organisations to put in place the necessary reforms to help the NHS to implement the directive sensibly. We will continue to do so, working closely with the professions to effect sensible and effective solutions to the very real challenges posed by the directive. Those measures have been backed up by additional investment to help accelerate the necessary changes.
	It is true that we do not accept the interpretation that the European Court has recently placed on the meaning of the directive, either in relation to the definition of working time or when periods of compensatory rest should be taken. As I said earlier when the right hon. Member for Charnwood (Mr. Dorrell) asked me to confirm it—I do so freely again—the decisions of the Court in both cases have made implementing the directive considerably more onerous and difficult for the NHS. That is true not just of the NHS in Britain, but for every health care provider across the EU. The SIMAP decision will have a particularly serious impact on the NHS, as it directly affects the pattern of resident on-call rotas worked by junior doctors. It does so, as the hon. Member for South Cambridgeshire rightly said, by requiring periods of time spent asleep but on call to count as working time.

Patrick McLoughlin: The Minister acknowledges that the judgment has made it worse for all health services in the EU, so why cannot and has not the Council of Ministers changed it?

John Hutton: We are working precisely to achieve that. If the hon. Gentleman can hold on to his hat for a moment, I will set out precisely the level of progress made at the European Commission and Council of Ministers level.
	As I was saying, the judgment has a particularly serious impact on resident on-call time. Given the existing pattern of resident on-call working in the NHS, it will be difficult to comply with that interpretation unless we employ thousands of additional doctors and radically change working practices and on-call rota arrangements. On the Jaeger case, I agree completely with the BMA that, in relation to when compensatory rest should be taken, the ruling is unworkable and unnecessary. Again, we argued in the European Court for a different outcome.
	As I have said, these cases have raised concerns right across the European Union. It is not just Britain and the NHS that will face difficulties in implementing the decisions. With the exception of Greece and Lithuania, all member states and all the accession countries have expressed their support for a review of those aspects of the directive. Together with the Health Ministers of Sweden, Denmark and the Netherlands, I raised our concerns over the impact of the rulings with the Commission last July.
	In January, the Commission began a consultation on amending the directive to deal with, among other things, the impact of the SIMAP/Jaeger rulings. On 4 March, European Employment Ministers, at their meeting in Brussels, recognised the need for changes to the directive on both of those matters. The Irish presidency concluded that
	"the key message from our discussions today is that an urgent European Union solution is needed to address the impact of the recent European Court of Justice rulings."
	On 17 March, Commissioner Dimas wrote to my right hon. Friend the Secretary of State, referring expressly to the SIMAP/Jaeger judgments. He commented:
	"I am aware of the practical difficulties experienced by the health sector in particular. As the commission indicated at the March Employment Council, I intend to bring forward legislative proposals on the working time directive before the summer."
	We very much welcome that acceptance on the part of the Commission that the directive needs to be amended.
	We have responded to the Commission giving details of the changes that we are seeking to the directive, and many other member states have done the same. Copies of these documents are available in the Library, and I assume that the hon. Member for West Derbyshire (Mr. McLoughlin) has familiarised himself with them. We will clearly need the support of other member states who have expressed their concerns over the two recent rulings. The proposals for change need to be taken forward as quickly as possible, because 1 August is looming. We will keep the House fully informed of developments in that area.
	In the meantime, good progress has been made in reducing junior doctors' hours. Our strategy has been twofold. We have sought first to develop an employment contract for doctors in training that reflects the requirements of the Directive and, secondly, to increase the size of the workforce substantially. We have achieved both.
	The new contract for doctors in training was successfully negotiated with the medical profession and put into effect in December 2000. The arrangements limit the maximum weekly working hours of doctors in training to 56, which is less than the 58 hours specified in the directive—

Andrew Lansley: The new deal.

John Hutton: Yes, the new deal. The arrangements also specify necessary daily and weekly rest requirements. To support the introduction of the contract, we invested in excess of £150 million over the first three years to implement the contract.

Henry Bellingham: What would the Minister's attitude be if junior doctors wished to opt out of the working time directive, perhaps because of shortages or particular problems in a hospital?

John Hutton: Under the terms of the directive, junior doctors are able to express such a preference. It is not the job of Ministers to say to individual doctors who wish to exercise that right whether they should or should not do so. That would be contrary to the spirit, letter and intent of the directive, because it is an individual choice for members of staff in the NHS and elsewhere. I fully support the retention of an opt-out in the directive, for the reasons that I gave earlier. It preserves flexibility, which all employment protection measures need if they are to work sensibly and not place unnecessary or unforeseen burdens on business or public services. It also allows us to keep our competitive edge, which is crucial in the context of the European Union. The Government's position on the opt-out has been made clear and I hope that I have dealt with the hon. Gentleman's concern.
	As a result of the new contract for junior doctors, there has been a substantial fall in the number of hours that junior doctors are working. It is also pertinent to remember that the hours that junior doctors work are self-certified, so it is not my figures—which is just as well—that show that but those of junior doctors themselves.

Martin Smyth: People who work longer hours have been required to be more open and honest, but is it possible that some junior doctors have not returned full details of the hours that they have worked out of a concern to keep the medical profession going and provide proper care for patients?

John Hutton: That is always a possibility and I would not rule that out in every individual case, but it is worth bearing it in mind that the statistics that we collect on the hours that junior doctors work are certified by them and they are paid a premium for working more than the minimum hours specified in the new deal. I strongly suspect that the figures are as accurate as we could hope them to be.
	In March 2001, immediately after implementation of the contract began, only 55 per cent. of doctors in training were compliant with the new deal requirements. However, latest figures show that 83.6 per cent. of all junior doctor posts are now fully compliant with the new contract, with 95 per cent. of all doctors in training compliant with the weekly limit on working hours. Substantial progress has been made on the part of the directive concerning maximum working hours. Regrettably, I did not hear any acknowledgement of that in the remarks of the hon. Member for South Cambridgeshire.
	We have also rapidly expanded the number of doctors working in the NHS. There are more than 7,000 more doctors in training working in the NHS today than was the case in 1997, when the right hon. Member for Charnwood (Mr. Dorrell) was in charge. The number of associate and staff grade doctors has also increased by more than 3,300.
	The expansion in the NHS work force is not confined to junior doctors. The number of consultant posts has increased by more than 7,000 since 1997, which represents an increase of 34 per cent., and we are making progress on increasing the number of doctors by a further 15,000 by 2008, over the 2001 baseline figure. That means that not only are we moving rapidly towards a consultant-delivered service, but we have substantially more specialist registrars to provide high-quality services and reduce further the work load of existing doctors in training. We have also met the target for an additional 1,000 specialist registrar posts 18 months ahead of schedule, and expect more to be established over the coming months.
	To maintain those increases we are also training a record number of medical students. Medical school intake in England has increased by 2,281 since 1997, representing a 60 per cent. increase. More than 6,000 students entered medical school in England in autumn 2003—the highest number ever recorded. The Government achieved their target of increasing the number of medical students by more than 2,000 places two years earlier than anticipated.
	We have similarly increased the number of non-medical staff working in the NHS. Between September 1997 and 2003, the number of qualified allied health professionals rose by nearly 11,000, exceeding NHS plan targets. By the end of September 2003, more than 16,300 former nurses, midwives and health visitors had returned to work in the NHS since February 1999. In total, there are an additional 67,500 more nurses working in the NHS today than in 1997. All those increases will help the NHS in meeting its obligations under the working time directive.
	I am sorry to have to say that, in relation to consultants and nurses, my amendment understates the actual numbers of additional staff that have been recruited. [Interruption.] I shall not withdraw the amendment, but at least on this occasion no one can accuse us of spin.

Rob Marris: My right hon. Friend has put his finger on the crux of the problem. The negotiations on the working time directive were concluded in early 1993 by the then Conservative Government, who messed things up. They did not foresee the problems that would be caused by the legal judgments or that would result for the training of medical staff. This Government are now sorting out those problems, given the length of time that it takes to train doctors and consultants.

John Hutton: I am grateful to my hon. Friend for those remarks. I am glad that he feels that I have got to the crux of the matter, although I believe that I am about to come to that—

Patrick McLoughlin: About time.

John Hutton: The hon. Member for South Cambridgeshire took 40 minutes to reach no particular point, so if hon. Members will be patient, I may be able to score at least one home run. That is all that I hope to do.
	Recruiting more doctors, although essential, will not, by itself, be enough. The rapid and extensive growth in doctor numbers represents a massive achievement for the NHS, which comes back to the point made by the hon. Member for Rochford—

Mark Francois: Rayleigh.

John Hutton: I apologise. That is where my sister lives. I do not think that she voted for the hon. Gentleman, although I had better check that. I doubt whether we could recruit the many thousands of additional doctors needed to meet the effect of the SIMAP and Jaeger rulings if our only response to the directive was to replicate existing patterns of working by junior doctors. That relates to the discussion about costings that we had in the European Standing Committee.
	The costings that we provided for the European Standing Committee were based on the assumption that the response was based solely on recruiting additional junior doctors and staff-grade doctors—those who are not consultants, but are not in recognised training posts. Although one cannot be 100 per cent. accurate, the cost of employing doctors is generally higher than the costs of recruiting additional nursing staff, and that was the point made by the Under-Secretary of State for Trade and Industry, my hon. Friend the Member for Bradford, South (Mr. Sutcliffe), when he summarised the debate in the European Standing Committee.
	I am sorry if the hon. Member for Rayleigh (Mr. Francois) felt that we had not provided him with the costings, but my hon. Friend was making the point that, if we need fewer doctors but more nurses, the overall cost of compliance is likely to be less than those figures, not more. By the look on the hon. Gentleman's face, I am still struggling to get that point across to him.

Andrew Lansley: If the Minister is making that argument, why does paragraph 3.1 of the UK response to the Commission on SIMAP and Jaeger say:
	"The cost of recruiting several thousands of extra . . . doctors . . . would run to hundreds of millions of pounds per annum"?
	It continues:
	"The alternatives to employing additional doctors, as set out above, are likely to cost approximately the same as recruiting more doctors."
	That is completely contrary to the point that the Minister is making.

John Hutton: No, with great respect to the hon. Gentleman, I do not believe that to be the case. The point that I am trying to make today—

Andrew Lansley: That is what it says.

John Hutton: No, it does not say that.

Andrew Lansley: It does.

John Hutton: If the hon. Gentleman wants to reconfirm the point, I will certainly give the Floor to him again.

Andrew Lansley: I was quoting one of the papers supplied to European Standing Committee C—the UK response of 27 February 2004 to the Commission questionnaire. The question from the Commission was:
	"Please specify, as precisely as possible, the additional costs directly attributable to the SiMAP and Jaeger case law."
	The Government said:
	"The cost of recruiting the several thousand extra middle grade doctors required for the UK would run to hundreds of millions of pounds per annum. This includes on-costs, overheads and training costs. The alternatives to employing additional doctors, as set out above, are likely to cost approximately the same as recruiting more doctors."
	That is not the point that the Minister is making.

John Hutton: It is. The costs are approximately the same; we are not saying that they would be in addition to the all-doctors option. [Interruption.] The hon. Gentleman obviously cannot digest the point that I am making—by the sound of it, nor can other Conservative Members.
	The options are the all-doctors solution, which we cost, and other options that involve the substitution of additional health care staff. Of course there will be costs, but, clearly, as we are not pursuing the all-doctors solution, they will not be those of the all-doctors solution. I do not want to labour my point any further, but, in general, the costs of employing nurses tend to be less than those of employing doctors—so, for obvious reasons, I do not want to go on any further about that issue.

Mark Francois: Will the Minister give way?

John Hutton: No, I will not; I have dealt with that point. [Interruption.] I am sure that the hon. Gentleman will make a speech and we all look forward with bated breath to his comments.

Mark Francois: Will the Minister give way, because he owes me a letter that I was promised?

John Hutton: No, I am not giving way to the hon. Gentleman.
	It does not make sense to pursue the option of recruiting additional doctors as the only response—

Mark Francois: On a point of order, Mr. Deputy Speaker. This is a serious point. When we debated this matter in the European Standing Committee, the Minister had to leave the sitting before the end. There were reasons for that and we did not quibble, but the Under-Secretary of State for Trade and Industry, the hon. Member for Bradford, South (Mr. Sutcliffe), who remained to the end, made an offer, as reported at column 34 of Hansard, that the Minister would write to me specifically on that matter to lay out the Government's case. I have that copy of Hansard here. I have not received that letter. That is the point on which I am seeking to persuade the Minister to give way.

Mr. Deputy Speaker: I understand the point that the hon. Gentleman is making, but ministerial answers to hon. Members' questions are not matters for the Chair.

John Hutton: I would certainly want to apologise if there has been any discourtesy to the hon. Gentleman in not receiving a reply from me. I will arrange for him to receive a proper response. I apologise to him if he has not yet had one.
	We need to expand the NHS work force, but our response to the directive must be focused on a wider array of fronts if we are to succeed in meeting the challenge that it presents. The crux of my difference with the hon. Member for South Cambridgeshire—I think that my hon. Friend the Member for Wolverhampton, South-West (Rob Marris) will agree—is that we need to re-examine the traditional ways of working, which have often placed too much of a burden on doctors in training, leading to long hours and sometimes unacceptable working patterns.
	New models of care and new ways of working are already being developed in many hospitals that utilise the potential of all staff, such as greater use of multidisciplinary team working. That will involve more staff working differently—staff working more flexibly to enhance patient care and improve NHS productivity. Those are precisely the sort of changes that the NHS should be making irrespective of the requirements of the working time directive, because they will allow hospitals to lessen the individual burden on some staff, while making the delivery of services more efficient.
	That work is being taken forward by 32 NHS trusts, which have been developing new roles in delivering NHS services since 2002, to meet the requirements of the directive. In fact, one of the trusts is in the constituency of the hon. Member for South Cambridgeshire, at Papworth hospital, which has been making significant progress. I am sure that that trust has kept him briefed. Some trusts, including that at Papworth, have tested new roles for non-medical staff, such as extending traditional roles for nurses and therapists and creating some entirely new roles. Some NHS trusts are developing new working patterns for doctors in training and others have changed the way that consultants work. Some have combined those approaches with changing the way that a service is delivered, taking the opportunity to streamline the service and improve the standard of care.
	For smaller district general hospitals—about which many right hon. and hon. Members will be concerned—the work of those 32 NHS trusts has shown that compliance with the directive can be achieved by a combination of such changes to working patterns, including full shift working for senior house officers and expanding roles for additional staff.
	Four NHS trusts—Homerton, which is now a foundation trust, Liverpool, Wirral and Morecambe Bay—are leading the work on the hospital-at-night project, which is considering different ways to provide acute care during unsocial hours. I think that the hon. Gentleman said that the British Medical Association devised the hospital-at-night project.

Andrew Lansley: I said that the medical profession initiated it.

John Hutton: I am grateful to the hon. Gentleman for that clarification, but that is not strictly the case, as I am sure, with hindsight, he will be aware. The hospital-at-night concept was jointly devised by the postgraduate deans, the Department of Health and the BMA. It has been co-ordinated by the Department of Health, and we are very happy to have the BMA's support.
	The hospital-at-night model proposes one or more multidisciplinary teams working in the hospital over night that, between them, have the full range of skills and competencies to meet patients' immediate needs. That is why the agreement on cross-cover that we have reached, to which I referred earlier, with the Academy of Medical Royal Colleges is so important. It will help to establish the right focus on patient safety and good clinical governance needed to underpin any such change.
	The work of the 32 NHS trusts involved in helping us to implement the working time directive shows—in a sense, this is the hub of the difficulty—that there is certainly no one-size-fits-all solution. The hon. Member for South Cambridgeshire assumed, for most of his remarks, that there was a solution and that the only reason why the NHS was having difficulties was that the Government had not told them the solution to the working time directive problem.
	The changes that are taking place in those 32 NHS trusts are replicable, but because every trust will have different circumstances, a different population to serve and a different work force to deploy, it will have to reach a view itself, based on its own experiences, about the kind of measure that it needs to adopt. Those 32 trusts have shown what can be done, and it is now clearly the job of the trusts that are not yet fully compliant to take the appropriate action to secure the maximum possible compliance. That is why I was particularly pleased that the House of Lords European Union Committee chose to highlight the positive progress—those were its words—of all the pilot sites in its recent report into the Commission's review of the working time directive, published on 8 April, two weeks ago. I have to tell the hon. Member for South Cambridgeshire that the comments of the European Union Committee stand in stark contrast to the assessment that he provided to the House about what is going on in the NHS today.
	The different solutions that are being developed in those pilot sites—both on what works and, clearly, what does not work—are being systematically shared with the rest of the NHS. We are providing targeted support to strategic health authorities to help them to identify the solutions that will help the trusts in their own areas and to get those solutions into every organisation that needs them.
	We have been reviewing the way that we train junior doctors to find out whether we can make the arrangements more efficient and effective. In parallel with implementing the working time directive for doctors in training, we are gearing up for a major reform of training itself. The modernising medical careers initiative will introduce better managed and better structured training programmes for junior doctors.
	It is clear that we in this country take much longer to train our doctors than is taken elsewhere, not because they get more training here, but because their training is not always well supported and, frankly, not always very well organised. That is why the modernising medical careers strategy is being introduced It will see us take a specialty-by-specialty approach to streamlining training, but it is clearly not a quick fix that will have an impact by 1 August. However, it is part of the Government's objective to build a better training environment for junior doctors. The initial phase will come on stream next year and we will develop the initiative with the academy, the BMA, the Royal College of Nursing, the NHS and others over the next few years alongside implementation of the working time directive to ensure that better training and decent hours are embedded side by side as we progress to the later stages of the directive's implementation.
	The role of the Department, which was the focus of the remarks of the hon. Member for South Cambridgeshire, is simply to support the NHS in meeting the legal requirements of the directive. That is precisely what we have been doing and we are doing this in the widest possible collaboration with the professional and regulatory bodies, NHS employers and those responsible for professional education and training. Measures that will help the NHS meet the requirements of the directive are being put in place and they are being implemented as we speak. I express my thanks and appreciation for the hard work of NHS staff up and down the country who are committed to this endeavour.
	Meeting the new requirements that recent case law in the European Court of Justice has imposed on us will be a considerable challenge for the NHS. I cannot assert that every shift worked by every NHS employee after 1 August will be fully compliant in all respects with every aspect of the directive. The decision in Jaeger alone makes that virtually impossible to achieve. That is why we are working actively to seek amendments to the directive and secure them at the earliest possible opportunity and why we are fully committed to retaining the use of the opt-out under the directive.
	The new contract for GPs was the second focus of the hon. Gentleman's remarks. As I understand it, the essence of his argument and the motion is that the extent of GP out-of-hours services will decline as a result of the new contract. That claim is entirely without foundation. It ignores both the statutory duties of primary care trusts to ensure the provision of out-of-hours services and the reality on the ground. In making his argument, he completely disregarded the new national quality standards that all out-of-hours service providers will be required to meet. They were introduced by this Government and are designed to deliver precisely the service that he now says that he wants to see in place.

Laura Moffatt: I am pleased that the House has got back to debating the quality of care for patients, which is the focus of the Government's amendment. I was concerned that all we seemed to be worried about was the way in which the contract is to be implemented. Will my right hon. Friend comment on the views expressed by a local GP? Dr. Amit Bhargava took the trouble to write to our local newspaper to explain to people in Crawley how important the GP contracts are and what changes they will involve. It is important that we move forward and provide a range of services for people and Dr. Bhargava congratulated the Government on taking the steps to do that. We need to return to that issue.

John Hutton: I am grateful to my hon. Friend for that contribution because it introduces a different perspective from that provided by the hon. Member for South Cambridgeshire. I shall return to his assessment shortly.
	The other problem with the hon. Gentleman's remarks is that they reflected a profound misunderstanding of the new contract. They gave rise to the obvious questions about what changes he would introduce to the new contract if he is as concerned about the situation as he claims to be. As in all the main arguments that he deployed, we heard absolutely nothing of substance from him.
	As the hon. Gentleman well knows, the new contracts are designed, in part at least, to deal with the long-standing concerns of GPs about the onerous nature of their statutory obligation to organise the delivery of out-of-hours services themselves. Under legislation agreed by the House last year, that obligation has been transferred to primary care trusts. It has not been dispensed with or evaporated; it is still there and is now the responsibility of PCTs where it properly belongs.
	As I do on many occasions, I agree strongly with Dr. John Chisholm, the chairman of the BMA's general practitioners committee, who, on the new contract and the existing responsibility of GPs, said:
	"The current 24-hour responsibility has deterred many young doctors from pursuing a career in general practice and has contributed to the current shortage of GPs"

Patrick McLoughlin: The Whitworth hospital in Darley Dale in my constituency provides a first-class service. It is a community hospital staffed by GPs and has a minor casualty unit that serves more than 8,000 patients each year. Does the Minister believe that the new GP contract reflects the work that the local GPs do and is there any danger that the services that I have described could be under threat?

John Hutton: I do not want to see any threat to such services. The new GP contract has absolutely nothing whatever to do with the work of GPs in community hospitals. That is secondary care, which has never been covered under the terms of their employment in primary medical services. The activity in secondary care that the hon. Gentleman describes has nothing to do with the primary medical services contracts of GPs, but I shall deal with that point in a minute because it is another one about which the hon. Member for South Cambridgeshire was not particularly well informed.
	The changes do not mean the end of out-of-hours cover. We know already that GPs will continue to be involved in delivering these services. We have made extra investment available to provide for that—something that the hon. Gentleman and the motion now seem to be concerned about. As he knows, GP practices are required to give proper notice of their wish to opt out so that appropriate alternative contractual arrangements can be made.
	The hon. Gentleman said that he drew some of his information from Pulse. I do not whether he has seen it, but I have a story that appears under the headline "Smooth start for first out-of-hours services after GP opt-outs". Perhaps he has simply not had the chance to see it or perhaps he decided not to use the story for reasons that others will speculate upon.

Howard Stoate: My right hon. Friend is being too modest about the achievements of the new GP contract. John Chisholm, in particular, is so enthusiastic about it because, for the first time, it allows GPs to broaden the range of services that they offer, to ensure that patients can be seen within 24 hours of request when that is considered necessary and to offer a new range of services that are currently carried out in the secondary sector. It has been shown many times that patients would far rather be treated by their own GP locally. Clearly, if GPs are to provide so much extra during the daytime to enhance patients' services, they will have to be able to rely on other professionals such as pharmacists, paramedics, nurses and other health personnel to take some of the burden off them for the services that might best be provided by other people anyway. The whole point is the enhancement of services and the integration of different skills within the health service to ensure that patients get a better deal throughout the entire patient experience and not just when they attend a GP's surgery.

John Hutton: I am grateful to my hon. Friend, because I can now dispense with what is left of my speech. I am sure that that is probably what everyone wants me to do. He is right. With respect to the hon. Member for South Cambridgeshire, he did not address those aspects of the reforms in any substance. In hindsight, I am sure that he would want to reflect upon that.
	We should also put the issue into its proper context, because the hon. Gentleman failed to do that. At present, fewer than 5 per cent. of GPs provide their own out-of-hours cover. Most practices have already delegated that function, prior to the new contract, to GP co-ops or have contracts with private providers, but that has not stopped GPs deciding to work additional out-of-hours shifts. I believe that that will continue to be the case.
	I am sorry that the hon. Member for Isle of Wight (Mr. Turner) is not here, because I was struck by the comments of one GP on the Isle of Wight recently. His practice recently decided to opt out of its statutory out-of-hours responsibilities, but he, along with his colleagues, is working additional out-of-hours shifts. That is being made possible because of the extra investment that we are making in those services.

Sandra Gidley: I had quite a lot of sympathy for the Minister's arguments until he said, "because of the extra investment that we are making in these services". I have spoken to the three primary care trusts covering my constituency and they all say that they are having to find extra money to introduce the type of service that they think the public expect and deserve. The amount that will be clawed back from GPs themselves will cover only about half the cost of the services that have been designed, and those services have been cut from the original gold-plated services. Will he assure me that, if my local primary care trusts need extra resources, something will be available?

John Hutton: It is always good, in these debates, to hear from a Liberal Democrat because clearly, for Liberal Democrats, there is no such thing as an NHS budget. On out-of-hours services, the hon. Lady is right: to opt out, a practice has to pay a proportion of its income back to the primary care trust, but that is only half of the investment available to trusts to fund out-of-hours services. We have doubled, in overall terms, the investment going into those services, and we have ring-fenced that money. It is one of the very few parts of the NHS budget that is ring-fenced, and that is precisely to avoid the difficulty, which the hon. Lady and others will, I am sure, speak about in a minute, of PCTs not having additional investment. It is up to trusts to make effective use of the resources that we have given them.
	I agree with my hon. Friend the Member for Dartford (Dr. Stoate) that we should make wider use of specialist nurses, and we should integrate out-of-hours services with walk-in centres and accident and emergency ambulance services. That is not a step backwards, as the hon. Member for South Cambridgeshire implied, but exactly the opposite. Out-of-hours services will continue to make full use of the services of GPs. The contractual vehicle will be different, but that is what GPs and the BMA have asked us to provide. We are working with them and with the National Association of GP Co-operatives to ensure that the new arrangements work well and in the interests of patients.
	I am not at all clear what the hon. Gentleman's position is. His motive, however, is crystal clear: to undermine public confidence in the arrangements that are being made by PCTs to provide out-of-hours cover. To give him some credit—I want to be even-handed—he has not wasted any time in setting about that task. The contract only came into operation three weeks ago, and only 10 per cent. of trusts have so far taken on responsibilities for out-of-hours services from their GP practices. He certainly got his shroud-waving in at the earliest opportunity.
	On community hospitals, the hon. Gentleman completely missed the point. The new contract for GPs has no bearing on the arrangements whereby GPs may provide medical cover for patients occupying beds in community hospitals; neither were those arrangements covered by the previous contract. Changes to the out-of-hours obligations in the new contract are therefore nothing to do with any instances where there may be a local dispute about payment for such cover.

Andrew Murrison: Will the Minister reflect on Warminster, where wards in the cottage hospital have closed because GPs have withdrawn their services, having taken the view that, although they are very happy to provide cover in the hospital as a bolt-on extra to their out-of-hours contractual obligations, they will certainly not do so in the absence of those obligations? That is happening right across the country. I am surprised that he does not know that.

John Hutton: No, it is not happening right across the country. There certainly was a problem in Warminster, and there have been problems in one or two other community hospitals—I acknowledge that. However, they are not to do with the out-of-hours arrangements under the new contract. The hon. Gentleman is wrong about that. The Minister of State, my hon. Friend the Member for Doncaster, Central (Ms Winterton), will address that point in her winding-up speech, and I am sure that the hon. Gentleman will want further to reflect on his arguments.
	Agreements that GPs may have with a community hospital are separate from their primary medical services contract and it has always been up to PCTs to decide locally how to commission that work as part of their broader commissioning strategy. The doctors and dentists review body itself expressed the view that the matter should form part of the wider review of staff and associate specialist grades that the Department is committed to undertaking. That is very much in line with how we would like to proceed. From 1 October, that will be a matter for the new NHS employers organisation.
	The Opposition's case is misplaced, misinformed, opportunistic and completely devoid of any practical alternatives to the path that we are pursuing, on both the working time directive and the provisions of out-of-hours services. It is not clear to me or, I suspect, anyone who heard the hon. Member for South Cambridgeshire whether the Opposition are in favour of the new contracts for GPs, whether they support the provisions in the contracts for out-of-hours services, or whether junior doctors should be covered by the directive. In that sense the hon. Gentleman was at least consistent in ensuring that his arguments lacked any substance, any sense of proportion or any recognition of what is happening on the ground. That is another reason why my right hon. and hon. Friends should reject the motion standing in the name of the Leader of the Opposition.

Paul Burstow: I start by referring to a speech that the Minister of State gave in January at a gathering organised by the Royal College of Surgeons. He said—[Interruption.] That is not this particular quote; I am afraid that the Minister of State will have to listen because this is a new quote from that interesting speech. On the working time directive, he said:
	"We have all analysed the size and scale of the difficulties ahead of us. They are real and obvious. But we need to do more than this. And we need to start taking the necessary steps now to secure implementation."
	The deadline for introducing the maximum average working time of 58 hours per week is 1 August. In January, only months before the directive has its full effect, the Minister was talking to a gathering of medical professionals about starting to take the necessary steps to secure implementation, which beggars belief.

John Hutton: The hon. Gentleman would have made a fair debating point if we had taken no action prior to my making that speech to the Royal College of Surgeons. I hope that he is prepared to be fair and acknowledge that.

Paul Burstow: That was a very early intervention, and I hope to explore in a little more detail some of the steps, and their adequacy, that the Government have taken since the working time directive first appeared on the horizon in 1998 and they made a commitment to implement it over the following few years. I take no lessons from the Minister at this stage, but I am sure that if he does not agree with other things that I have to say he will take the opportunity to catch your eye, Mr. Speaker, and intervene.
	The January speech is proof, if proof were needed, of the dither and delay that was exposed, and dealt with in detail, in the examination by the House of Lords European Union Committee. I shall outline my reasons for that conclusion. It is not as if the directive has come out of the blue. The Minister and his colleagues have had five years to grapple with its implications for the NHS. Ministers have known about the SIMAP judgment since October 2000. The NHS is now having to deal with the interactions of a whole series of decisions taken by this Government over the past five years. Both the GP and consultant contracts start to kick in just when the directive begins to bite. In combination, those three major changes have a huge effect on the medical work force and their capacity to sustain current levels of activity and, indeed, to deliver ever higher standards.
	In their submission to the European Commission the Government stated that the UK requires between 6,250 and 12,550 more doctors to comply with the directive—a lot of extra doctors. The Minister outlined, both in his speech and in the amendment to the motion, the Government's progress on recruiting and training more doctors. The BMA says that compliance with the directive will result in the loss of the full-time equivalent of 3,700 junior doctors. I know that that figure is contested, but the Minister did not, in his speech, demonstrate why it is not an accurate assessment.
	All that has to be seen against a backdrop of the poor, even non-existent, work force planning of the 1980s and 1990s and the legacy cost of neglect and under-investment by an earlier Administration. The failure of the last Conservative Government to expand medical training places and the current Government's decision to stick to Conservative spending plans for their first two years in office have undoubtedly exacerbated capacity constraints and the Government's ability to be in the right position to ensure full compliance with the directive by August. Even now, the Royal College of Physicians says that there are insufficient junior doctors in training. Some might say, "Of course it would say that," but it is nevertheless worrying that it flags that as a serious concern.
	I agree with the Minister that the answer to the working time directive is not simply more doctors; it is about doing things differently. The hospital at night project, which has been discussed across the Dispatch Box, is one measure that needs to be taken. Whether it was suggested by the BMA or the royal colleges, or whether it was a Government initiative, does not much matter; it is what comes out of it that matters and whether it delivers the additional capacity to allow us to deal with the consequences of the directive
	The 32 pilot schemes that are being trialled through the country provide opportunities to innovate and experiment in different ways of working, to manage demand and so on. However, although local initiatives such as the ones that are being implemented to change the skill mix, expanding the roles of nurses, midwives, therapists, pharmacists and others, point a way forward, and although there has undoubtedly been an improvement in the work force size over the last few years, the most recent work force survey suggests that we still have shortages of midwives and some of the key therapist roles that are key to making a reality of the individual initiatives being implemented throughout the country. Such initiatives have a part to play, but it is far from clear whether they can be implemented across the NHS before the 1 August deadline. The Royal College of Physicians said that its survey showed substantial scepticism about whether the introduction of nurse practitioners would enable hospitals to cope with fewer doctors. Indeed, the House of Lords European Union Committee argued in its recent report on the directive that although the Government are testing new ways of working in their pilot schemes, invitations for proposals, as we have heard, were not issued until April 2002, four years after the directive was first implemented. The results are unlikely to be ready by August, and the Committee concluded that it would take up to two years for successful schemes to be fully implemented across the NHS. Effectively, there will be a further two years of non-compliance with the directive, so it would be useful if the Minister of State, the hon. Member for Doncaster, Central (Ms Winterton) confirmed whether the Government agree with the Committee's conclusion and whether it will be two more years before the learning from the pilots is applied across the NHS.
	The Committee went on to report that no more than 50 hospitals will be in a position to implement the methods trialled in the pilots. Do the Government accept that conclusion and, if not, why not? How do their conclusions differ from the Committee's? The Government acknowledged in their submission to the European Commission that the alternatives, as we have heard in today's debate, may not cost more than employing extra doctors but will certainly cost as much, so it is not a cheaper option for the NHS to get round the problem with upskilling, changes and skill mixes. In its brief for today's debate, the NHS Confederation states that it will not be possible for many NHS organisations to meet the compliance requirements by August 2004. The Government clearly agree, given what the Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton) told the House today. Indeed, the confederation goes on to warn that some trusts will not be able to provide safe medical care in some specialties if they introduce compliant rotas. Trusts face an invidious choice between damaging patient care and failing to comply with the directive. The confederation urges the Government not to adopt a punitive approach when dealing with non-compliance. It would be useful if the hon. Member for Doncaster, Central explained in her reply to the debate how the Government intend to deal with trusts that are not in compliance with the directive, not least because the right hon. Member for Barrow and Furness said that many trusts will not be compliant. Presumably, those trusts will be dealt with case by case.
	According to the Royal College of Physicians, six out of 10 hospitals still do not have the 10 middle-grade staff necessary for a compliant rota. More worrying still, almost four out of 10 hospitals say that they have fewer than eight middle-grade staff, so they are well short of what is needed to deliver compliant rotas. In the speech that the right hon. Member for Barrow and Furness made in January he said that
	"there should now be a process in place in every NHS Trust and PCT that allows these issues to be fully explored and discussed."
	Why, in January, did the right hon. Gentleman think it necessary to say that such a process should be in place? Surely it should have been in place for a long time.
	The Government have issued inadequate and vague guidance to hospitals on the implementation of the directive. To start to develop a road map just months before the deadline for implementation is breathtakingly incompetent. Ministers say that the directive could have been complied with were it not for the European Court rulings in the SIMAP and Jaeger judgments. The SIMAP judgment, however, was made in October 2000, and dealt with the issue of what is meant by working time. That was further complicated last summer, as the right hon. Member for Barrow and Furness said, by the Jaeger judgment, which gave an unworkable definition of when compensatory rest should be taken. The European Commission made a welcome announcement on 4 March that it would propose legislation to deal with the problem, but the Minister of State did not explain the timetable for the legislation. It will be proposed by the summer, but the European election will inevitably cause a hiatus. It is speculated that it could be two more years before we have a legislative solution that gets us off the hook. It would therefore be helpful if the Minister spelt out the timetable.
	The motion also deals with community hospitals and the link between their capacity and the GP contract. The right hon. Member for Barrow and Furness was right that there is not a direct causal link between the GP contract and the issues affecting community hospitals, but there is undoubtedly some interaction that is causing GPs who work in community hospitals to abandon that work. There are 400 community hospitals in the United Kingdom that provide 10,000 beds and rely on about 4,000 GPs to provide key services. Those hospitals are crucial to the system. They provide a safety valve for district general hospitals, and are increasingly becoming centres for rehabilitation and intermediate care. There is a genuine possibility that the new GP contract will have the unintended effect of causing GPs to withdraw from work in community hospitals, as has already happened in Bolsover, Clay Cross and, as we have heard, Warminster. Wherever that happens, salaried medical staff are used as an alternative, but when they take on GP roles in community hospitals they are subject to the working time directive, so costs increase. That has not been factored into the Government's costings, and is connected to the point made by my hon. Friend the Member for Romsey (Sandra Gidley) about the inadequacy of resources to implement changes in the contract.
	Will the Minister explain why her Welsh and Scottish counterparts have embarked on negotiations on community hospitals? They are more concerned about the issue than the Government in England, and have started negotiations to ensure continuity of care and to enable GPs to continue to fulfil that role. There is no similar process, however, in England to avoid the fallout after 1 January next year. Will the Minister therefore explain what negotiations are planned in England to deal with the problem of GPs deciding to give up working in community hospitals, and when those negotiations will start? If the problem is not resolved it will compound the pressures on district hospitals.
	The new consultant contract, which aligns pay with sessions worked, is a welcome innovation in the NHS. However, the Government appear to have underestimated the amount of work that consultants have undertaken in their costings, plans and implementation of change. If those hours are not funded, they will not be worked. If they are not worked, the extra consultants trumpeted in the amendment will not provide extra services, and the Government will merely be treading water as a consequence.

John Hutton: I apologise for intervening on the hon. Gentleman, but there are some things that I must correct. The British Medical Association agreed the funding envelope for the consultant contract.

Paul Burstow: That was not part of my argument, but I am grateful for that additional information. I do not think that I uttered "BMA" at all in the context of the consultant contract. There appears to have been an underestimate of the work done by consultants. The BMA may have agreed to something, but that does not necessarily invalidate my assertion and the evidence in the Health Service Journal and other journals that this growing problem is causing severe budgetary problems, especially at year-end. Strategic health authorities put it at the top of their list of financial pressures. The right hon. Member for Barrow and Furness may say that the contract is fully funded, but time will tell. I hope that the hon. Member for Doncaster, Central will explain that the Government are satisfied that there is no mismatch between consultants' historic work load and the work load that they will undertake under the new contract, as that may well have a serious impact in future.
	In conclusion, there is very little time in which to implement the working time directive. The scale of the task, as has been outlined, is huge. Ministers have had ample time to plan and prepare for the implementation of the directive, but have failed to realise the impact of a range of measures that they are implementing this year on the working time directive. As a result, Ministers will have to rely on the hard work, professionalism and good will of front-line staff to get them out of a hole that they dug and that they will now expect the staff to bail them out of.

Several hon. Members: rose—

Mr. Deputy Speaker: Order. Before I call the next hon. Member to speak, I remind the House that Mr. Speaker has placed a 12-minute limit on Back-Bench speeches, which applies from now.

Kerry Pollard: I welcome the debate and feel reassured that doctors' hours in the NHS are being reduced. When I or any member of my family or any constituent of mine needs to be treated through a scheduled operation or as an emergency, the last thing I want is for them to be treated by a tired doctor. Even though doctors are dedicated to the task in hand, when they get tired they might not be as sharp as they could be. We must remember that it takes seven years to train a doctor, and probably as long to open a medical training school. I am pleased that a medical training school has been opened in my region, the east of England, at Norwich, and will no doubt be turning out doctors very quickly.
	We have excellent GPs in St. Albans. My own practice, Midway surgery, sees patients within 48 hours. It carries out minor operations and runs many clinics. Another, the Kedia practice, has just had a brand-new surgery built that will provide state of the art services to the people of London Colney, a village in my constituency. I have written to my right hon. Friend the Minister to see whether he can come to open the new surgery shortly. In addition, we operate a collective stand-by service in St. Albans, StaDoc, which covers the whole constituency. It is hoped that this group will provide doctor cover to enhance the service at the minor injuries unit at our city hospital, which is nurse-led and is wonderful. I visit the place regularly. Staff there can deal with all but the most serious injuries, and they deal with them in minutes, not hours.
	Many people seem to delight in knocking our health service. Recently, our local newspaper did so on its front page with banner headlines attacking the failure to meet accident and emergency targets for waiting times. One week later I discovered that, on average, 5 per cent. of people booked in for operations do not turn up. They do not ring up to let the hospital know; they just do not bother to attend. That appeared on page 17 of the local paper with a modest headline and received little coverage.
	As I said, having been given an appointment for treatment, some people do not turn up. They give no reason and no advance warning. A leading surgeon told me that he had known the rate to be as high as 25 per cent., but the average was about 5 per cent. In the day surgery unit, which does 100 operations each week, 5 per cent. is the equivalent of two and a half weeks of operations not carried out when theatre space had been allocated and clinical staff were ready to operate. That is a waste of resources. If those operations had been performed, many people could have been taken off the waiting list.
	Measures are in hand to ensure that, as far as possible, the figure of 5 per cent. is reduced. For example, hospital staff ring the patient, where possible, a few days before the due day to ensure that the patient will turn up. In addition, a list is being compiled of people who can be called at short notice to fill possible vacancies. It is still outrageous that people who have been examined, had an operating slot scheduled and had preparatory work done do not show up. There is a two-way bargain, with the health service scheduling operations and doing preparatory work. The patient's side of the bargain is to turn up on the right day at the right time, ready for the operation.
	I recently spent a morning in our city hospital day surgery unit, where I was told about the non-attendance. I was due to meet the morning list of patients and follow one patient from pre-med to operation, post-operative care and then home. The patient chosen was a young man who had been suffering extensive back pain for some time. He was programmed for a cortisone injection in his spinal area. That sounds simple, but it is fraught with danger. The man had a local anaesthetic and was fully conscious through the entire procedure. The nurse responsible chatted to him throughout, reassuring him. The whole procedure was facilitated by the use of X-ray photography to enable precise positioning of the injection site. That meant that all of us had to wear lead aprons, which are extremely heavy.
	The surgeon and the anaesthetist explained the whole procedure to me in detail throughout the operation. The procedure did not take long but was carried out very carefully indeed—an impressive performance, nothing like "ER" or "Casualty". I observed the patient in recovery and joined him later back in the ward, where he had some tea and toast and was then discharged. I have spoken to him since and he tells me that his back pain is much eased. As well as being a recently appointed fellow of the Royal College of Midwives, I now feel emboldened to apply to become a fellow of the Royal College of Surgeons.
	Emboldened by the Minister speaking about his sister, I want to mention my mum, who will be 84 next Monday. I wish her many happy returns. For the past two years, she has spent much time in and out of hospital, and in the main has been treated very well.

Mr. Deputy Speaker: Order. What the hon. Gentleman is saying is very interesting. Is he soon going to get on to the subject of doctors' hours?

Kerry Pollard: I may well do that, Mr. Deputy Speaker, now that you point it out. Doctors' hours are extremely important and my right hon. Friend the Minister alluded to the steps that will need to be taken so that we have the right number of doctors. We need more training places, and I am pleased to say that we are working with the university of Hertfordshire to try to set up a medical training school there, which will ensure that we get the right number of doctors. I know that the university vice-chancellor, Professor Tim Wilson, and his team are keen to provide such a facility. With the large new state of the art hospital, which we hope will be built in Hatfield, close to the university, we should be able to link the two together—a new hospital and a medical training school to provide the doctors we need, to ensure that we can comply with the working time directive, and to ensure that operations are carried out properly, doctors are not too tired, and a full and efficient service is available to our constituents as patients.

William Hague: I am grateful for the opportunity to take part in the debate. I do not intend to follow my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) and the Minister down all the wider issues, or to bring up any relatives, as the House will be relieved to hear. I want to make a brief and simple point about the problems of rural areas. Of course, I have in mind my constituency, Richmond in Yorkshire, and issues that have arisen in Wensleydale in my constituency. I know that the Minister who is to reply to the debate, the hon. Member for Doncaster, Central (Ms Winterton), knows Yorkshire, so she may well be able to visualise the area about which I am talking.
	I fear that changes in GPs' hours and possibly the working time directive, which I shall mention briefly, impact particularly hard on rural areas. Health service resources are spread more thinly and, of course, GPs are spread more thinly in those areas. I am referring to very rural areas—in my constituency, the top end of Wensleydale, where ambulances do not arrive as rapidly as they do in the rest of the country. Everybody understands that that is a problem and something is being done about it, but it will probably continue to be a problem. The accident and emergency department of the hospital in Northallerton is over 40 miles away for my constituents—an hour's drive and more, in many cases, and much more in bad weather and difficult road conditions.
	My constituents feel remote from the health service in any case, so GP practices are particularly important in such an area—disproportionately so. People feel they rely on GPs even more than in the rest of the country. They rely on them heavily because there are more elderly people than in the country as a whole. Vast numbers of tourists come in and quadruple the size of the population, which is not usually taken into account, as far as I can see, in the way that resources are deployed. Many people work with machinery on farms, and roads are particularly winding and difficult, so there are more accidents than in the country as a whole. The reliance on GP services in those areas is considerable.
	The contract that has been agreed, which has many merits, which is right in principle—as everybody has said—and which is important for the recruitment of GPs into the health service, applies as much to rural areas as to everywhere else. I make no criticism of the local doctors who are taking part in the contract, which will lead to new out-of-hours arrangements. I make no criticism of the local trust, the Hambleton and Richmondshire primary care trust, which is doing its utmost to work with the new situation and has assured people that it believes there will be no reduction in the quality of their out-of-hours service. Nevertheless, it is unarguable that that is a major challenge for the trust. I do not believe that when these things are negotiated between the British Medical Association, GPs and the Department of Health, and when they are considered in the Department, the needs of very sparsely populated rural areas are considered.
	Let us consider what the situation means in practice for my constituents. If they live in upper Wensleydale, they have to telephone the local surgery and get another number to telephone York or Catterick. That is like telling someone who lives in central London that if they think that they need a doctor in the night, they must telephone Northampton and a doctor might be able to come from Luton. The same sort of distance and travelling time are involved, except that in this case there are hills in the way. There is often heavy snow on them in winter, and fog or ice can make journeys almost impossible. In those circumstances, it is not surprising that people are anxious about the implementation of the new contract.
	As I said, the primary care trust is doing its utmost to make the arrangements work and is putting resources into that. Four-wheel-drive vehicles are being purchased with every type of cell phone and satellite navigation. That is the subject of some local cynicism, as the locals all know where the telephones will not work and that satellite navigation can reliably deliver people to a field at the top of Wensleydale and will not necessarily bear any relation to where the houses are. With all the technology available on earth, finding a cottage on top of the dales on a dark night in bad weather is still an extremely difficult thing to do. People are worried that the doctors who know the immediate locality will not be attending them in the night, and that if doctors are called out to make a 30-mile journey and a 60-mile round trip, they will not be available to other people at the same time.
	The anxiety about this matter in rural areas is wholly understandable. There is a good deal of resentment. Last week, a farmer put it to me that if he has a sheep that is ill in the night, it will be attended to by a vet who lives locally—vets are still a principal part of our community in the Yorkshire dales—and who already knows the medical history of that sheep and its relations, whereas if one of his family is ill in the night, that service will certainly no longer be available. That is how people regard the situation, which is understandable, even though great efforts are being made to ensure that an out-of-hours service works for that part of the country. I reiterate that I am making no criticism of all the people who are trying to make that service work.
	We do not know how the issue will work out. The Minister pointed out extremely fairly that we are in the early days of these new out-of-hours services. That is certainly the case with regard to how they will apply to remote areas such as upper Wensleydale. The jury is out and we do not know how the services will work. In the past 10 days, there has been some controversy in my constituency about how they are working. There is dissatisfaction about the fact that, on a bank holiday such as Easter Monday, large numbers of tourists visit the area, but in an out-of-hours time. When people have road accidents after 6 o'clock, the local GP service is not available to them, and neither are the air ambulances for which we have raised large sums at charitable occasions in my constituency precisely because of the remote nature of the locations.
	There is a feeling that access to health care has been reduced. I hope that that feeling will prove to be misplaced, but it is the feeling and suspicion of many of my constituents in areas such as Wensleydale. When these matters are considered in future, the needs of sparsely populated rural areas must be given greater weight. The people who live in such areas have paid their taxes and national insurance. Yes, they understand that there are difficulties in providing services in particularly remote rural areas, but they are entitled to have their particular needs taken into account. When the application of general rules and agreements starts to mean that care and resources are more thinly spread geographically, the needs of sparsely populated areas really come into play.

John Hutton: I am grateful to the right hon. Gentleman for giving way and for the tone of his remarks, with which I have a great deal of sympathy. He might not be aware that we have recently announced some additional resources for primary care trusts serving constituencies such as his, in rural areas where out-of-hours service providers will undoubtedly face additional costs. We are trying very hard to ensure that those additional costs are reflected in the allocations.

William Hague: Yes, I am aware of that. I do not know whether the Minister was in the Chamber when I spoke about the resources going into vehicles, cell phones and satellite navigation. Those resources are certainly being deployed. We do not know whether they will be sufficient to deal with the task, but it is necessary to have additional resources for sparsely populated rural areas, and I think that it is necessary to consider whether exactly the same rules should be applied to such areas in negotiating contracts and working hours or whether exceptions should be made.
	The working time directive leads to a wider debate that I do not want to go into, except by joining many people in the country in expressing astonishment that the European Union should make any such rules at all. I do not see why it is in the interests of people living in France, Germany or Italy to regulate the working hours of doctors in this country, and I do not see why such decisions should be made in any other place than this country. When the Minister has to come to the House and say how much the Government are trying to fight court judgments that we all agree are manifestly not in the interests of this country, it shows how much power has passed to unaccountable institutions. That is a wider debate, however; the Prime Minister wants us to have it in great detail over the next 18 months, and we will enjoy that.
	My point about the working time directive is simply that it is another of the forces that makes things more difficult for sparsely populated areas. The Minister spoke about the small hospital trusts and the attention that has been given to them, and recognised that the problem is more difficult for them. In terms of rotas, it is more difficult for hospitals that have access to a limited number of consultants and junior doctors to cope with such issues. He is trying to give them particular help, but my point is that such issues accumulate over the years. Changes in the training requirements that may be set by royal colleges and agreed with the Department of Health have made things more difficult for small hospitals. It continually becomes more difficult for small hospitals to continue their existence. I am not being alarmist about that—there is no threat whatever to the Friarage hospital in Northallerton—but I know that it gets harder every year for people to run a small hospital. That requires either that exceptions be made or that greater resources be given to such hospitals.
	Notwithstanding the point that the Minister has just made, account of population sparsity is not systematically taken in the allocation of health service resources. If we are to continue to apply sweeping national or supranational rules to situations that are unusual and needs that are difficult to satisfy many miles from the nearest hospital, we will have to take into account in funding allocations the needs of the particular rural areas involved.
	I hope that that will be borne in mind in future. I do not think that any changes can be made to the contract now and I am not proposing any such changes. Obviously, that contract is signed and done, so I am not saying that any immediate action can be taken. However, I think that we will have to address these issues and that the Department of Health should be conscious that, when it considers matters from an urban and suburban point of view, as is often the tendency in Whitehall and in this House in what is mainly an urban and suburban country, we need to give increasing attention to the particular problems of rural areas.

Howard Stoate: It is always a pleasure to take part in health debates, especially because, as the House knows, I still carry on a certain amount of medical practice myself.
	We are debating a very serious issue and, as the right hon. Member for Richmond, Yorks (Mr. Hague) rightly highlighted, it will cause a certain amount of anxiety among constituents. I acknowledge his point about thinly populated rural areas where services are sometimes difficult to provide. None the less, debates such as this give us the opportunity to debate some of the issues in public so that people can be reassured about what the Government are doing to address them.
	We have to balance the needs of service provision—ensuring that patients have access to appropriately trained, alert and awake medical personnel of all types, specialties and subjects—against the need for training requirements of a high standard and teaching requirements to ensure that personnel pass on their knowledge to others, as well as the need to ensure that they can carry out research and have a decent family and out-of-work life. All those things require a delicate balance that it is sometimes very difficult to achieve. Of course, we must also ensure that we balance all those issues against financial management and the best possible use of resources for the taxpayer.
	This afternoon, we have talked extensively about the new GP contract, which I welcome and which, for the first time, allows GPs to provide a wide range of evidence-based services. One of the main advantages of the new GP contract compared with the old GP contract is the enhanced, additional services that GPs can provide. The evidence-based services are based on evaluated research and proper evidence, so GPs can be sure that when they carry out, for example, diabetes care, care for people with hypertension or care for people with Alzheimer's, it is based on research-based evidence, and they can be sure that the care is worth while. That improves GPs' morale enormously, because they know their work has a measurable benefit and a measurable outcome.
	The old GP contract was full of what the people who wrote it may have perceived to be good ideas, but the ideas were not evidence-based. Many GPs found the contract extremely difficult to understand, and they often felt that they were wasting their time, which had a serious deleterious effect on the morale and recruitment of GPs. During my career as a GP, I noticed recruitment falling, with fewer good quality young people coming forward to be GPs. Young doctors often said that they could not understand the way general practice was going, that a GP's work was not based on sound science and that becoming a GP did not seem to be a good career progression, and they therefore turned away from general practice into the hospital sector, which was regrettable.
	The new GP contract has improved morale and recruitment, and John Chisholm, who chairs the GP committee of the British Medical Association, is enthusiastic that it will produce the GP recruitment drive that we need. The BMA rightly points out that the country is short of GPs, and there is serious under-recruitment for general practice. It is vital that we attract the best quality graduates into general practice as a career choice—and, for the first time in many years, the new GP contract provides hope that that will be the case.
	If GPs are to provide enhanced services during the day to allow patients to see them within 24 hours, where they feel that that is necessary, and to access services within their communities in GP surgeries, we must use other health professionals to fill in the gaps. It is not credible that we can expand the work load indefinitely without asking other health professionals to share it. I am pleased that we are working on a new pharmacy contract, which will allow pharmacists to take away much of the burden currently carried by GPs.
	Pharmacists are highly motivated, highly trained professionals, who do not always use their skills to the best of their abilities because the current pharmacy contract does not allow them to do so. The pharmacy work force will be acknowledged by the new contract that Ministers are currently negotiating with the profession, which will add enormous extra depth to the health care provision. The new contract will apply equally to out-of-hours and in-hours services because many pharmacists already provide an extended-hours service at weekends and in the evenings, and they are accessible without an appointment simply by patients dropping in to see them. That is one more strand of improved health care provision to which we can look forward.
	I am also pleased that the BMA has negotiated a new consultant contract with the Government. I am concerned that many trusts have not yet implemented the new consultant contract, and I have recently met BMA members who share my concern that there are serious local implementation issues. Some trusts have not taken up the new consultant contract in the right way, and I would like to know what the Minister can do to make sure that the new consultant contract is developed to the maximum and that all consultants will benefit from it. The consultant contract allows extra resources and more productive career development patterns for consultants, but it requires local negotiation.
	If we look back a few years, we can see what the medical work force used to be like. I was a junior doctor not that many years ago—it is certainly within living memory. When I was a junior houseman, I worked a "one in two", which meant that my contract for a fortnight was 208 hours—one week I worked 136 hours, and the following week I worked a mere 72 hours. Those were my contracted hours, but the work often overran because of sickness, holidays or study leave, so the situation was even worse than that. When I was a junior doctor, a one-in-two contract was the norm, and most doctors were working those hours. I am pleased that those days are long gone because I do not want to see such contracts again.
	Even when I was a junior GP, I was expected to work a full night shift, which often meant getting out of bed several times during the night, and to get into work at 8 o'clock in the morning to carry out a full morning surgery. It was unrealistic to expect doctors to undergo such pressure and provide good care to patients. After a night on call, for example, I was on a ward round in the morning and was confronted by the consultant, who said, "Would you like to explain this new patient who arrived last night?" I said, "What new patient?" He said, "This one in this bed." I said, "I am sorry. I have not seen this patient before." The nurse jabbed me in the ribs and handed me the notes. I had clerked in the patient during the night—I had made extensive notes that turned out to be quite good—but I could not recollect the case in the morning because I was so tired. That sort of thing is clearly bad for patient care, and I am glad that those days are long gone. Things have moved on tremendously in the health service, and I am pleased that doctors' hours now allow them to undergo the right training and research and to have lives of their own, which ensures that they are not overtired and do not potentially put patient care at risk.
	I should like to address one or two local issues in my constituency. Yesterday, I visited my local hospital, the Darent Valley hospital in Dartford, to witness the opening of the first new operating theatre of its type in the country. It is called OR1, and it is a state of the art, brand new, fully automated, computerised operating theatre, where the entire range of medical instruments and equipment hangs from the ceiling and the consultant has a fully computerised control panel. While the world's media watched via a video link to the hospital's postgraduate centre, Mike Parker, the surgeon, carried out an operation with the new equipment while Andrew McIrvine, his colleague, relayed information to us in the postgraduate centre as we watched an interesting operation to remove a patient's gall bladder.
	The new equipment is fantastic, and it is wonderful to see Dartford at the forefront of the process, because the technology is brand new and Darent Valley hospital is the first hospital in the country to use it. The resources, commitment and investment are going into the health service, and future patients will benefit from that. I am sure that such equipment will be installed in hospitals around the country because of the Government's investment.
	There have been enormous improvements in NHS training and patient care, and there have also been improvements in general practice. Many general practices are being rebuilt to improve access to care for patients, and many GPs are taking on extra medical and nursing staff to allow them to provide extra care. However, the work force's needs must be balanced against patients' needs and taxpayers' needs to ensure that we get best value. Adjusting the skill mix to use the right profession in the right way is clearly the bedrock of ensuring the delivery of best quality care.
	I welcome new initiatives such as the GP contracts, and I welcome the working time directive, which allows us to rethink how we provide medical care in this country. The working time directive is a challenge and, as the Minister says, it presents significant problems in some parts of the country. I am sure that all hon. Members recognise that there are difficulties in some areas and that the new arrangements must be bedded in before we can make the best use of them.
	The situation has improved so much in the past few years. We look forward to sustained growth, development and investment, which will allow hospitals to improve their facilities, and GPs and pharmacists to improve their range of services, which must be the way forward to ensure that everybody in this country has increased health care and life expectancy. I welcome the debate, I am pleased to have had the opportunity to address the House this afternoon, and I look forward to the Minister's reply.

Stephen Dorrell: Most of what I have to say this afternoon concerns junior doctors' hours, but before moving on to that question, I must say that I agree with almost everything that the hon. Member for Dartford (Dr. Stoate) has just said. In particular, I agree that it will be possible to develop primary care under the new general medical services contract.
	One might have hoped that he would take a view back into history, to before 1997 in his remarks about making out-of-hours services more flexible so as to reflect the needs of the medical profession, as well as of the patient; the development of a more flexible local definition of what general medical services means, including local contracting through the practice management system; the development of a broader range for pharmacists; and the development of services that are available through GP surgeries. The development of primary care did not begin miraculously in 1997, or even, I hasten to add, in 1979—it has been carried through by Governments of all political complexions over a long period, and is an important success story for the national health service, whatever the political label of the Government at its head at any particular moment in time. I agree with what the hon. Gentleman said, but he is not entitled to claim exclusive credit for the process as one that started on 1 May 1997.
	That is a broadly non-partisan comment. I hope that what I am about to say about junior doctors' hours is also non-partisan, but I suspect that it will lead to rather less agreement across the Floor of the House. Anyone who has attended health service debates over many years knows that the whole subject of junior doctors' hours in the NHS is a very long-standing issue. In the period before 1990, in particular, and cumulatively over several years, it got seriously out of control. There is no argument about the fact that the position before the introduction of the new deal could not be defended in the modern world. Doctors were being asked to work in circumstances that did not provide high-quality training for them or high-quality care for their patients.
	I was a junior Minister when the new deal was signed and Secretary of State for two years during its implementation. That process started in 1991 and went on regardless of the change of Government that took place in 1997. The commitment first to recognise that there was a real problem with junior doctors' hours, then to do something about it, was shared across the political divide. More importantly from the point of view of both doctor and patient, it was being addressed by the health service as employers and by doctors' representative organisations—the British Medical Association and the royal colleges—without the need for a legislative framework to oblige them to do so. The situation had clearly become insupportable—action needed to be taken, and it was.
	That is why I asked the Minister whether he felt that the adoption of the legislative framework of the working time directive makes the delivery of the shared objective of better management of doctors' hours easier or more difficult. As there was a clear commitment to do something about it, and action was being taken by the employer in agreement with the profession, I genuinely do not understand why the Government see no conflict between delivering that desirable objective—which is shared across the House—and the adoption of a legislative framework that, as the Minister recognises, makes it more difficult for him to do so.
	In understanding that conundrum, it is important to understand why addressing the issue of junior doctors' hours is extremely difficult for the health service management and for the training authorities of the royal colleges. If it were simply a matter of saying, "People should not work ridiculous hours—let's change the law and do something about it," it is reasonable to assume that somebody would have done something about it before the situation got as serious as it had by the late 1980s.
	There are difficulties in ensuring that the medical work force have sufficiently diverse training to deal with the wide range of circumstances that they will need to be able to cope with in their professional practice. My right hon. Friend the Member for Richmond, Yorks (Mr. Hague) talked about the difficulties involved in delivering medical cover in community hospitals. That applies not only to very remote rural areas, but in relation to, for example, the delivery of maternity services and minor accident cover in community hospitals, which is an issue that regularly arises in the life of a health Minister. That is compounded by the—entirely benign—move in the medical profession towards increasingly specific sub-specialisms.
	All those factors make it hard to deliver a proper training regime for doctors alongside a commitment to reduce working hours. The fact that the issue is complex and difficult, and is recognised as such, adds extra point to the question of why it is necessary to introduce a legislative framework that complicates the delivery of a shared, if admittedly difficult, policy objective, given that the only result of introducing that framework is to make the delivery of the objective even more difficult. The Minister stressed that we should not seek to adopt a one-size-fits-all approach, but that is precisely the result of introducing an unnecessary legislative framework, because history demonstrates that the issue was being resolved before that framework, which will make it more difficult, was introduced.
	As my right hon. Friend the Member for Richmond, Yorks said, the difficulty is compounded by the fact that we are talking not only about a legislative framework but about a legislative framework that is being introduced in a European context. That means that the Government as the employer cannot ultimately introduce the changes that are necessary to make the policy deliverable. It is worth remembering that the working time directive was introduced by the authorities in Brussels under the single market legislation because it was felt to be necessary to deliver a single market. It is perverse to imagine that the free movement of goods and services around the European Union is promoted by confusing the problem with the delivery of junior doctors' hours in our, or indeed anybody else's, health service. That is why I do not understand why the Government welcome the introduction of a legislative straitjacket the result of which is to make the delivery of their policy objective, which I share, more difficult.
	The Government are entitled to some sympathy, given that—to employ the much-used cliché—we are where we are. We have a legislative framework, and the Government have to try to obey the law and to deliver their policy objectives within the health service. They have to try to square that circle. The hon. Member for Sutton and Cheam (Mr. Burstow) pointed out that the legislative framework has been in existence since 2000, and we are now talking about August 2004, but we have a very unclear idea about how the circle is to be squared—we are simply asked to rely on the words of the Minister, who is sure that it will be all right on the night.
	It really is not good enough to say that that European working time directive might have been okay, but the problem was compounded by the SIMAP judgment. The SIMAP judgment concerned the definition of the phrase "working time" as it applies in the medical profession, and it was about a very simple question: does time that is spent on call count as working time? One does not have to know much about the history of this issue to know that that question goes to the heart of the management of doctors' hours during their training. That is what all the arguments were about throughout the 1980s and 1990s. In 2000, legislation was introduced, as far as we know without active disagreement by the Government, on the extension of the working time directive to cover the medical profession, but without having decided, and leaving it to the courts to decide, the fundamental question of whether "working time" refers to time on call or time treating patients. It is a pretty broad-brush measure. Although it deals with extending working time legislation to junior doctors' hours, it does not define working time.
	The charge against the Government is that they were content to allow the measure to be introduced without properly considering the implications and the definition at its heart. It has been in force, complete with the interpretative judgment, for three and a half years, and we still await any clear idea about the way in which the Government intend to interpret it. They have been caught asleep on the watch during an important health service development and consequently patients are at risk.

Adrian Bailey: I welcome this debate. The issues that it raises are serious issues that local health care professionals have drawn to my attention, and we now have a welcome opportunity to discuss them in the Chamber.
	Having said that, I think that the motion is alarmist and concentrates narrowly on specific aspects of the subject. It is designed not to shed light but to cloud the positive benefits that have accrued from the Government's health policies and to spread an impression of impending doom and gloom. It also reflects one significant failure in Government health policy—the inability to cure the parliamentary Conservative party's collective amnesia about its record in government.
	There is a debate about the robustness of the British Medical Association statistics, but let us assume that they are robust. Conservative Members' reaction to them, as reflected in the motion, is out of all proportion when compared with the predicament in which they left the health service in 1997, when there were 224,000 fewer staff, including 60,000 fewer nurses and 19,000 fewer doctors. The amendment outlines other figures, which I am told are understated and therefore not spun. To continue the cricketing metaphor, it is a question of reverse spin. Even on the Opposition's gloomiest prognostications, the staffing and ability in the NHS to meet the challenges that the debate covers are hugely improved since the Government came to power in 1997.
	Let us consider one or two specific matters. General medical services contracts and the European working time directive and its impact on junior hospital doctors' hours have been discussed. Although I do not contest the difficulties that those policies may cause in some circumstances, their overall thrust accords with recognised priorities that have existed, as some Opposition Members said, for a long time. The effect in reducing junior hospital doctors' hours and giving general practitioners betters hours, more flexible working and greater reward will hugely enhance the attractiveness of the medical profession to would-be trainees and help to realise the Government's objectives for the doctor provision that is necessary for the nation's growing health needs.
	I was surprised by the weight that the Opposition attached in the motion to out-of-hours services. In my discussions with my local primary care trust, the issue has not been raised. The gloomy forebodings in the motion do not appear to be reflected in reactions on the ground. I checked with my local doctors' surgery and was told that the service would continue as it had done previously and that there would be no deterioration.
	My constituency is in a traditional inner-city area, Sandwell, which has historically suffered a range of health problems. Even now, life expectancy is considerably below average and the area has historically been provided with too few doctors. However, if one examines what is happening on the ground, the motion does no justice to the true picture in an area that has suffered from under-provision and deals with a greater range of health problems than the average. My surgery, which is less than 300 yards from where I live, is expanding. It is due to have two extra doctors, is extending its premises and will become a university training centre.
	The Neptune health centre in the middle of Tipton deals with one of our most deprived communities. It intends to take on a range of services that the local acute hospital previously provided. The Tipton care organisation and the Great Bridge partnership for health have pioneered new, joined-up and flexible working, which has involved GPs working with physicians' assistants and a range of nursing support. That has meant taking on roles and responsibilities that only specialist doctors undertook hitherto. In Sandwell, there is a pioneering flexibility in the provision of health care, which, by having multi-skilled groups dealing with a much wider range of health needs than under the former model, epitomises the Government's approach.
	The motion fails to convey exactly what is happening on the ground and is therefore misleading. The Minister and all hon. Members can cite statistics, but they do not do justice to what is happening, either. When talking to local health professionals in my area, I have been impressed not so much by statistics as by the almost evangelical spirit that they have displayed in meeting the sort of challenges that the area presents, and by the way in which the new structures, working methods and funding have boosted their morale. They recognise that measures such as the European working time directive are a challenge and that there are problems in recruiting doctors. Such problems have always existed in my area and the retirement of the first generation of Asian doctors will present further problems.
	However, health professionals not only recognise the problems but know that they can deal with them. The potential funding exists and there is an opportunity to make the case to meet the challenges ahead. I have been hugely impressed by the way in which they have sought to embrace the Government's agenda. Consequently, health care is improving in my locality.
	The European working time directive presents challenges and the European Court of Justice judgment creates difficulties. However, the extra funding, staffing, new ways of working and missionary zeal that I have noticed in so many local health care professionals means that the challenges will be met. The health care professionals are much better placed to do that through the Government's policies. We should reject the motion because it fails to recognise that that is the reality on the ground.

Richard Taylor: My one fear and regret about this debate is that I might not be as welcome as I believe that I am at the moment to sit on this side of the House after I have said what I am going to say, and that the kind Opposition Whips who alerted me to the debate might not do so again.
	I had an Adjournment debate on this very subject last November and the Minister who responded was all too aware of the worries resulting from the European working time directive. Also in November, the all-party group on local hospitals held a meeting which was addressed by the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton). We were impressed by the amount of work that he had done on this matter and the urgency with which he viewed the situation. I am, therefore, slightly encouraged, as I was encouraged by some of the things that the Minister said.
	The Minister said that the Department of Health was giving priority, when implementing the working time directive, to maintaining quality and access to care. That is crucial. He also said that redesign—not relocation—would take place around the needs of local people. He added that we must not substitute tired consultants for tired junior doctors. I sympathise with the comments made by the hon. Member for Dartford (Dr. Stoate). I was a junior doctor rather before he was. He was on a one-in-two rota, but I was on a one-in-one rota at a hospital that used to exist about half a mile from here. That really went far beyond a joke. I did not just forget things like he did—I actually cracked up in the middle of the job. It is therefore essential that we do not substitute tired consultants for tired juniors, and that we take note of the working hours involved.
	The Minister also said that the role of the Department was to support the NHS to meet the requirements of the directive. I want to take a few minutes to emphasise that I believe that the Government have another supremely important role to play. They have to take the part of citizens and patients, in some cases almost against the doctors. I want to draw to the attention of the House a letter in a recent edition of the British Medical Journal from a Scottish consultant neurosurgeon who was writing on the ills that afflict the NHS. He wrote:
	"These include the new deal, the consultants' contract, the general practitioners' contract, the European Working Time Directive—all man-made artefacts and all preoccupied with the welfare of doctors, not patients."
	I want to bring that letter to the attention of the Government so that they can be aware of how some people might look at the changes and to note some of the snags involved, some of which have already been mentioned today and on other occasions. They are worth mentioning. The first—and, to me, the biggest—involves the risk to the continuity of care. With full-shift systems, the same doctor never looks after a patient for any length of time, and, given the pressure of work, handover processes can sometimes be rushed. Continuity of care is therefore crucial.
	The second snag involves training. Junior doctors, particularly surgeons, and trainers are questioning whether the reduced hours are giving them enough exposure to the practical procedures and operations in which they have to be supremely competent when they achieve consultant status.
	The third involves lifestyle. The Royal College of Physicians recently studied 57 hospitals across England and Wales, and found that 63 per cent. of the medical specialist registrars on full shifts were working seven nights in a row. That cannot be comfortable for family life and it is not popular. Certainly, trainee obstetricians have found cover on full shifts very unpopular. Particular problems have been raised in relation to anaesthetics, obstetrics and paediatrics, which are services that cannot be covered in hospital at night by a generic doctor. Those specialisms pose extra problems. The answers obviously involve employing more doctors and the Government have given us figures to prove the numbers that are coming on stream. We have also heard a lot about doing things differently and there are some very good plans in that respect.
	It appeared from what the Minister said in his opening remarks—I hope that the Minister of State, the hon. Member for Doncaster, Central (Ms Winterton) will confirm this—that the review being carried out in Europe might well lead to some delay in the implementation of the changes. The British Medical Association warns that, even if there is a suggestion of delay, implementing legislation to bring it about could cause further delay. The NHS Confederation makes a good point in a recent briefing note, saying:
	"We recognise that it is the Government's responsibility to ensure that the working time directive is implemented but where despite trusts' best efforts it is not possible to achieve compliance, it is vital that there is a positive and supportive rather than a punitive response from the Department of Health and SHAs."
	Given the snags with the new deal that I have mentioned, the working time directive and the new contract, hospitals are at risk, particularly certain large hospitals that are situated relatively close together. I am thinking of some in my own part of the country, including those in Telford and Shrewsbury and those in Gloucester and Cheltenham. The Government must ensure that it is possible for all those hospitals to preserve the emergency facilities that the people in those areas require. There is a particularly worrying triangle in the north-east of England, around Hartlepool, Middlesbrough and Stockton. Their hospitals are all close together and are all providing all the services at the moment. As we are well known in my part of the country for campaigning, Hartlepool has already been in touch with us to ask what it can do to protect its hospital.
	There are also many smaller hospitals throughout the country that are somehow managing to maintain accident and emergency services. One has only to think of Banbury, Hexham, Workington, Bridlington, Newark and Louth. I could provide a long list of others. Those hospitals must be at risk. All this is taking place against the background of the Department of Health's paper published in February last year, "Keeping the NHS local: a new direction of travel", which I welcomed. It expressed the intent of Government policy to keep the NHS local, which is certainly compatible with local wishes. The Government will recognise that, if that is not possible, there will be a risk of political flak from various communities.
	An excellent leader appeared in the British Medical Journal recently, written by Andy Black, the well-known health service management consultant. He stressed the political risks involved in downgrading emergency services and made two useful recommendations. The first was that the Royal Colleges should find a way of connecting with the public perception of the need for local access to emergency services. The second was the use of real "managed clinical networks", which would result in a real sharing of services. It is no good having an accident and emergency unit, and, 20 miles away, as is the case in Worcestershire, a minor injuries unit that is totally separated from it. If they worked together, with the same staff rotating between them, the staff working in the major unit would know the problems of the minor unit and the sorts of cases that the minor unit could see, which would avoid unnecessary journeys. Andy Black put his finger right on it when he said:
	"If the price of moving the complex emergency to an appropriate centre of expertise is that this patient is accompanied by another nine or 10 patients who are not complex acute cases then another set of problems is launched."
	That is exactly what we are seeing in Worcestershire—those nine or 10 patients who did not need to be moved are causing tremendous other problems.
	On the GP contract, I was puzzled by the Minister's comments on community hospitals and I hope that his hon. Friend will return to the matter in her wind-up. I must admit that I thought that community hospitals were going to be at risk with the new contract.
	I will say little about the consultant contract. I am slightly worried about today's announcement of 25,000 extra orthopaedic operations. Will that take NHS consultants away from NHS duty and make continuity of care even worse?
	I ask the Government to remember that the NHS is for the patients. It is up to the Government to be the ordinary citizen's advocate and to ensure that changes are acceptable to the public, not bulldozed through as some previous changes have been.

George Young: It is a pleasure to follow the hon. Member for Wyre Forest (Dr. Taylor), who speaks with such authority on this subject and whose very presence in the Chamber is a reminder to us all of the potency of health as a political issue in our constituencies. He mentioned that he was approached by Hartlepool, whose local hospital is threatened, for advice. I hope that he advised that an independent candidate should stand against the Labour Member there to achieve some results.
	I want to speak briefly about the new GP contract, which I broadly welcome. Of course, it makes sense to reduce the number of hours that doctors work. If it makes no sense for MPs to be up all night and then be expected to do a proper day's work, it makes less sense for the country's doctors and GPs to have to attend to their patients when they have not had a decent night's rest.
	I sound a brief note of caution before Ministers make claims about the impact of the new contract on patients. The Minister of State, who is normally alert and fleet of foot, does not understand the depth of concern in constituencies about what will happen when the new out-of-hours contract is introduced. The evidence that I have seen is that patients in my constituency will feel worse off because the level of service will be manifestly less than it is at the moment. If steps are not taken before 1 July, when the new out-of-hours opt-out contract starts in Hampshire, Ministers may find it difficult to convince my constituents about their investment in primary health care and their commitment to a quality service.
	There are three areas of concern on which I want to touch: first, cover at Andover hospital—the position is the same at other smaller or cottage hospitals; secondly, the loss of Saturday surgeries; and thirdly, the operation of the new out-of-hours contract, which in my case is with Primecare. None of that is the fault of the local PCT or the local GPs. Simply, the money saved by not paying GPs to provide out-of-hours cover, even when topped up by new money from the Department, is not enough to replicate the service that GPs currently provide, mainly because it was provided on the cheap.
	Let me begin with Saturday surgeries, which have not really featured in this debate. At the moment, I can see my GP in Andover on a Saturday. For those who commute from Andover or who work long hours, that may be the only time that they can see their GP without taking time off work. Last Saturday, my GP saw 15 patients and processed a number of repeat prescriptions. With the new contract, Saturday is out of hours, so the local GPs are not contracted to provide any service on that day. They could do so if the local PCT bought it in as a local enhanced service, but my PCT does not have the resources to do so, a point to which I will return in a moment.
	My PCT is struggling with funding for taking over the out-of-hours service. It has been allocated 6 per cent. of what is called the global sum, part of the GP income stream, and GPs have taken a commensurate reduction. But that is simply not enough to replace the service. I know of only one GP practice that is going to open extra-contractually on a Saturday and that is a dispensing practice in a neighbouring constituency that can do so from the dispensing surplus. None of the surgeries in Andover will be accessible on a Saturday.
	In fairness, there are plans for a replacement GP service. On Saturday and Sunday, there will be five sessions at Andover hospital operated by a GP or GP registrar. It may be bookable, but, basically, it is open house. Of course, one will not see one's own GP and the GP whom one sees will not have access to one's records. For most people, the hospital is more difficult to access then their local medical centre, so by any definition, the service offered on a Saturday will be seen by my constituents as reduced.
	Then we have the position of Andover hospital. Andover is the largest town in my constituency, with a population of 40,000 and growing. The Andover War Memorial hospital hosts a range of services, including out-patients, diagnostic imaging, day surgery and so on. For anything more serious, one must go 15 miles to Winchester. At the moment, out-of-hours cover at that hospital is provided by local GPs, so one can go to the minor injuries unit at any time and be treated. A nurse deals with the patient and, if required, a GP will be called out. Although details of the contract after 1 July are still being negotiated, it looks very much as if there will be no local GP cover at the hospital out of hours. From 6.30 pm to 11 pm, some service may be provided by nurses, but from 11 pm to 8 am, it looks as if the minor injuries unit will be closed. At the moment, people can look in at 2 am and get treated. As from 1 July, those who want that treatment will have to drive 15 miles to Winchester to get it—by any reckoning, a reduction in service.
	Finally, there is the operation of the new out-of-hours service to be provided by Primecare and funded through the PCT. At the moment, calls from patients in Andover are answered by a local nurse until 11 pm and thereafter by the on-call doctor in person. In future, the plans are to route calls initially to Birmingham and then to Southampton—the local hub—and if a GP is required, he will drive from Southampton or possibly Winchester. At the moment, cover in Andover is provided by a rota of local doctors and the response is obviously much quicker. However that is presented, it will be seen locally as a reduction in service.
	I want to end on a theme that, I am afraid, I have mentioned previously. The reason for all this is that Hampshire, and particularly Mid Hampshire PCT, is simply underfunded. For every £100 that the average patient in England gets, Mid Hampshire gets £80. At that level, it is simply not possible to provide the quality of service that Ministers and I, as the local MP, want. That is why in all the debates on heath services in Hampshire, whether primary care or secondary care, we return to the underlying structural imbalance in the way that funds are distributed. Until Ministers address that fundamental point, they will continue to have difficulty persuading my constituents that the NHS is as good as they make out.

Andrew Murrison: This has been a good debate, throughout which excellent speeches have been made. I was particularly struck by the quality of the Conservative speakers, who included no fewer than three Privy Councillors.
	A number of interesting points have been raised. It is a pity that the Minister was ever so slightly prickly in his opening remarks, for he had no need to be. Our motion was tabled in good faith. While we broadly support much of what has been discussed today, we have problems—problems raised with us by our constituents. It is right and proper for us to counsel caution when it comes to matters that affect a vast work force, one of the biggest in the western world. I hope that Ministers will take that in good spirit, and will do their level best to respond to the genuine concerns that have been expressed.
	The Opposition believe that the health and safety of doctors and their patients should not be compromised. Doctors should not be forced to work unacceptably long hours. We have heard from two doctors today, who spoke of one-in-two and even one-in-one rotas. I worked a one-in-two rota for two years. I would like to say, in a curmudgeonly sort of way, that it did me no harm; but I will not say that, because I suspect that it did harm me, and I am sure that it did not do my patients any good at all.
	I think back to 1991, when a Conservative Government produced "The New Deal for Junior Doctors". It was a good piece of work but, sadly, by March 2002 the BMA was complaining that a third of juniors were still working beyond the limits set by it. During the intervening time, we had failed to get to grips with what I consider to have been a very positive measure. That leaves me somewhat concerned about the future of the working time directive, and Ministers' sincere and well-meant efforts to improve things for junior doctors and, most important, the patients in their charge.
	In January the Minister of State told us:
	"Complying with the Working Time Directive need be neither costly nor a burden."
	I trust the Minister implicitly, but I have sought a second opinion. I have written to 170 acute trust chief executives asking for their views on how things stand. I asked them what problems they envisage in the meeting of deadlines, what assistance they are being given by Government, and how they think it will all pan out in the months ahead. I have received good, if mixed, responses. As might be expected, those from people making their careers in the health service are fairly positive. In general, they constitute measured and reasonable attempts to address the big problem that all the respondents clearly face.
	One word occurs time and time again—"challenging". All the respondents feel challenged by the directive. "Challenging" can mean many things, not necessarily bad, but I believe that in the context of my inquiry those people really do feel up against it. I am not surprised that no one now seriously believes that the targets that have been set will be met throughout the NHS—the Minister said as much today. It would be interesting to know where the trusts stand in terms of the penalties that may apply if they do not meet those targets; I should like to hear what the Minister thinks.
	The Minister says that trusts have been given £46 million to meet the costs of compliance. I must press him on that. The matter was debated in European Standing Committee C, but, as my hon. Friend the Member for Rayleigh (Mr. Francois) pointed out earlier, we have not been given all the answers that we would like to have been given. It is all to do with quantifying the costs. Last month, in the Committee, we finally managed to elicit from the Minister the fact that compliance could cost up to £780 million and require between 6,000 and 12,000 more doctors. The upper limit exceeds even my estimate, based on my poll of acute trust chief executives. It also exceeds the BMA's estimate. If the Minister genuinely believes that the cost will reach that level, we need more details—in writing.
	I was further confused by a written answer, which I received only yesterday, to a parliamentary question that I tabled 10 days ago about the methodology used by Ministers to arrive at these figures. I was told:
	"Actual costs or numbers of additional staff required are not held centrally and could not in any case be disaggregated from the overall cost of NHS growth and modernisation."
	That is rather odd, coming from a Government with an insatiable demand for data relating to targets they have set with a view to the generation of politically obliging headlines, which we see all the time. I really must press Ministers on whether they are sticking to the figures of up to £780 million and between 6,000 and 12,000 doctors—and, if so, on how those figures are derived.
	The Minister of State made a confusing statement concerning the guidance that was issued to European Standing Committee C about the possibility that that upper figure might be shifted downward if we used alternative means of providing the cover currently provided by doctors. I hope that the Minister will clarify that in her closing speech because, if it is wrong, we should know about it.
	Paragraph 3.1 of the guidance says:
	"The cost of recruiting the several thousand extra middle grade doctors required for the UK would run into hundreds of millions of pounds per annum. This includes on costs, overheads and training costs. The alternatives to employing additional doctors as set out above are likely to cost approximately the same as recruiting more doctors."
	Are we saying that £780 million is a reasonable reflection, or are we seriously saying that by changing working practices and using other health care professionals the figure can be brought down, because that is not what the Department's own written guidance says? I seek clarification from the Minister.
	The Government have rightly increased the number of places at medical schools, but I would like to know how they arrived at the figures that they think are required. We have heard that they feel that between 6,000 and 12,000 more doctors will be needed to satisfy the working time directive, but I cannot believe that the number of places provided at medical schools has been calculated on an empirical basis. I hope that the directive and its strictures have been factored into the assessment that Ministers have presumably made of how many doctors we will need in the future.
	An historical example emphasises the point in a cautionary way. In the 1970s, consecutive Governments predicted the number of dentists that we might need now, based on the incidence of dental caries and the fact that fluoridation was predicted to reduce it. Unfortunately, they got it wrong, and that is at the heart of our current problems with NHS dentistry. We do not want to repeat such a mistake, do we?
	The working time directive was incorporated into domestic legislation in 1998, yet it was 2002 before invitations were issued to undertake pilot schemes in the NHS. It is not good enough for Ministers to say that the problem with the roll-out of those schemes has been anyone's fault but the Government's. It is unreasonable to say to trusts that they have not got their act together, as it is clear when one considers the time scales involved that the fault does not lie with them at all. Indeed, contrary to Ministers' assertions, many of them have been quite enthusiastic about the schemes. I cite in particular the hospital at night schemes, which many of them have warmly embraced, and rightly so. Of course they favour the more efficient use of human resources, but none of the ones that I consulted is under any illusion that hospital at night or any other piloted scheme could address the staffing shortfall. One trust said:
	"None of the projects has achieved working time compliance and they have required central funding which may not be available when the initial project ends."
	Yesterday, we saw the most extraordinary three-point turn in recent political history. The Prime Minister might have set something of a trend. If so, in the new spirit of openness, it would be refreshing to hear whether Ministers, in retrospect, are content with the way in which they have handled the implementation of the European working time directive, or whether on reflection they share the obvious concerns expressed by the trusts that I have consulted.
	As EUROSTAT has shown, our health service is fundamentally different from those in Europe. We have 1.4 junior doctors for every senior doctor, while Europe has one junior for every four seniors—it is turned on its head. We have the fewest doctors per head of population in Europe. Because of the slack in Europe and because it has proportionally far fewer juniors, it is arguably better placed to implement the directive with relative ease, while our NHS will clearly struggle with it. The NHS will clearly feel challenged by the directive; "challenging" is the word that has come across time and time again in the consultation exercise that we have undertaken.
	That is surely all the more reason for the early pilot schemes that we simply have not had. There were four wasted years between the implementation of the directive in 1998 and the invitation to conduct pilots in 2002.

John Hutton: The hon. Gentleman has just tried to make the argument that only the UK faces that particular pressure for additional doctors. I do not know whether he has read the submissions that all the other member states of the European Union have made to the Commission, itemising the difficulties that they face in implementing the directive, but if he has, he will have seen the long list of additional doctors that Germany, France, Sweden, Holland and Italy all require to meet the terms of the SIMAP and Jaeger judgments. This is not just an English problem.

Andrew Murrison: Of course it is not just an English problem. The point that I was trying to make by giving EUROSTAT statistics is that our NHS is fundamentally different from systems that operate on the continent. I am sure that the Minister accepts that and, in particular, the statistics on the ratio of junior doctors to senior doctors. Clearly this matter primarily involves junior doctors, and if the Minister cannot understand that, he merely underscores my concerns. We know that there are far more doctors per head of population in Europe than in this country. Clearly, the employment environment in the health service in this country is fundamentally different from that which applies in Europe, which makes the roll-out of the European working time directive far easier in Europe than in this country. I am sure that the Minister must admit that.
	Several right hon. and hon. Members have rightly discussed cottage hospitals, and I am worried, from the Minister's remarks, that he perhaps does not fully appreciate the impact that the GP contract might have on community hospitals. I have cited my specific example and from the conversations that I have had, I am sure that it is mirrored up and down the country.
	It is just not good enough to say that the new GP contract has nothing to do with any contractual arrangements that GPs may have with community hospitals. There are clearly bolt-on effects. Although I accept that there is limited direct linkage between GPs' contracts to provide out-of-hours cover to their patients and their arrangements with community hospitals, in practice, as I am sure other hon. Members will bear out, GPs facing the removal of their out-of-hours obligation will not then subscribe to the knock-on obligation to community hospitals to which they currently subscribe. That is the current problem for community hospitals. If the Minister does not appreciate that, he must go back and examine the matter, which is a real concern in my area and many others. We have heard about it in other contributions today.
	"Keeping the NHS Local", published in February 2003, was a good document that Ministers perhaps need to dust down and remind themselves of. They need to remind themselves—I hope that they will be reminded of this in the big conversation—that people want their health care delivered locally. Will Ministers please dust down "Keeping the NHS Local" and apply it to the current problem of GPs opting out of their community hospital cover? Two of my community hospitals, in Warminster and Westbury, have already sustained closures this year, in the stroke unit and one of the general wards. Those closures are directly related to the current debate on GPs' hours.
	We have heard about Saturday morning surgeries, and we might also have heard about the problems that GPs will face on Monday mornings. If there is perceived to be inadequate or patchy cover over the weekend, people might be queueing up on a Monday morning to get the treatment that they want from their doctor. I hope that Ministers are looking into that.
	The Government have known since 1998, and arguably earlier, that the European working time directive would pose serious problems to the NHS. They should have known about the potentially devastating implications of the new GP contract for community hospitals. Ministers knew that staffing costs would rise, and that the supply of doctors would be insufficient for needs. They knew that any extra money for the NHS would be mopped up by some of the extra costs brought about by a series of initiatives—not only the European working time directive—introduced since 1997. Disingenuously, they have referred to extra doctors when they should have been talking about the likely reduction in doctor hours available to the service by 2009. They have over-hyped cash flow, knowing full well that much of that will not reach the front line. It is little wonder that our constituents stand aghast as Ministers deliver evermore upbeat assessments of improvements in the NHS.

Rosie Winterton: In introducing this afternoon's debate, the Opposition have alleged that Ministers are somehow complacent about the implementation of the European working time directive in respect of junior doctors' hours and have failed to anticipate the effect of the new GP contract on out-of-hours cover. On the Government side, we have shown that that is plainly not the case.
	The starting point of the debate is whether doctors ought to be working excessive hours. We believe that, whether they are working in hospitals or general practice, it is bad for doctors to have to take critical decisions while overtired and overworked. That was eloquently described by my hon. Friend the Member for St. Albans (Mr. Pollard).
	My fellow Minister of State made it clear in his opening contribution that on the issue of out-of-hours cover, the Opposition have ignored both the statutory duty of primary care trusts to provide it and what is actually happening on the ground. As my right hon. Friend said, at the moment only 5 per cent. of GPs provide their own out-of-hours cover. GP co-operatives and private providers already carry out most of the cover and we are continuing to work to ensure that the new arrangements work well and in the best interests of patients.
	The right hon. Members for Richmond, Yorks (Mr. Hague) and for North-West Hampshire (Sir George Young) drew attention to some of the difficulties in bringing about out-of-hours cover and the right hon. Member for Richmond, Yorks particularly drew attention to what is happening in rural areas and to the challenges that they face. I was pleased that both Members drew attention to the hard work being put in to ensure that there is no reduction in services, and they received assurances that that would not be the case as more resources were going in. As my right hon. Friend said, specific allocations have been made to rural areas on top of the extra £350 million targeted to support out-of-hours services.
	With regard to the working time directive and junior doctors hours, my right hon. Friend told the House that because of the recent decisions of the European Court of Justice, implementation of the directive will be very demanding for the NHS. The right hon. Member for Charnwood (Mr. Dorrell) also referred to that. We agree about the difficulties, which is why, together with other European countries, we have made clear our concerns—and the Commission has accepted that the directive needs to be amended. My right hon. Friend gave the House an assurance that he would keep it fully informed of developments in that respect.

John Pugh: Will the hon. Lady also emphasise that Ministers have constantly been in touch with the small hospitals group and that meetings have taken place with those hospitals and with the Royal College of Physicians to discuss the working time directive and the European dimension?

Rosie Winterton: Yes, my right hon. Friend has certainly met them and continues to engage in discussions with them.
	At the same time as successfully making representations to the Commission, we have put in train a number of measures to reduce junior doctors' hours, to increase the numbers of doctors in training, and to establish pilot schemes to look into the implementation of the working time directive. In doing so, we have made it clear that our priority is to implement the directive in a way that maintains both the quality and accessibility of NHS services—a commitment praised by the hon. Member for Wyre Forest (Dr. Taylor), who also praised the work of my right hon. Friend the Minister of State. I mention that because my right hon. Friend was not in his place at the time.
	My hon. Friend the Member for West Bromwich, East (Mr. Watson) referred to new ways of working that will be necessary to ensure that we maintain service provision. For example, he highlighted in his area the better use of nurses' time and skills. My hon. Friend the Member for Dartford (Dr. Stoate) mentioned that as well, and referred particularly to the role that pharmacists can play. We need to consider the role that they can play under the new contract, and my hon. Friend knows that I strongly support such a move.
	The hon. Member for Sutton and Cheam (Mr. Burstow) raised the issue of what would happen if trusts were not compliant. Pilots spread best practice, as we know from the results so far, and it is unlikely that the whole of a trust will be not compliant. Certain areas will have particular difficulties, including, for example, obstetrics—as the hon. Member for Wyre Forest pointed out—and, possibly, paediatrics.My right hon. Friend the Minister of State meets regularly with the BMA and others and will issue guidance on problems that may arise in such specialties.
	The hon. Member for Westbury (Dr. Murrison) raised the issue of cost. As my right hon. Friend said, some £46 million has been provided to assist with compliance, but it is impossible to disentangle plans for compliance from trust plans to modernise and improve services generally, as well to meet other key NHS priorities. We have not asked trusts to quantify costs separately as that would be an added burden. Planning for working time directive compliance forms part of overall NHS planning, but in each trust the solutions will need to fit local circumstances, which will differ from place to place.
	The hon. Members for Westbury, for Wyre Forest and for Sutton and Cheam raised the issue of community hospitals and out-of-hours services. I reiterate that the new general medical services contracts have no bearing on the arrangements whereby GPs provide medical cover for patients occupying beds in community hospitals. Agreements that GPs may have with a community hospital are separate from their primary medical services contracts, and PCTs should decide locally how to commission such work as part of their broader commissioning strategy. Discussions have taken place in Warminster, and continue to take place. Three months cover has now been provided, as the hon. Member for Westbury knows—we have corresponded on the matter—and the minor injuries unit has been reallocated to Westbury.
	Yet again, the Opposition have shown us that they are less interested in solutions and what is best for patients, staff and those who make our health service work, and more interested in sniping about the NHS and undermining those who work in it. That is not surprising, because when they were in power the attempts they made to reduce working hours for junior doctors were too little, too late. When in power, they also cut trainee numbers. This Government have reduced the hours of doctors in training: 95 per cent. of them now work for 56 hours or fewer a week. This Government have increased work force numbers so that there are almost 7,300 more consultants and 67,500 more nurses than there were in 1997. This Government have increased the number of medical school places so that 6,030 students entered medical school in 2003.
	Also, this Government's new GP contract has been welcomed by the BMA as being
	"better for patients and better for everyone working in general practice".
	The Government welcome the overall aims of the working time directive to ensure humane working hours for doctors, but those on the Opposition Front Bench have not learned any lessons. They have not said that they would recruit more health staff than we are recruiting already; nor have they said what reforms to contracts and working practices they would introduce. In fact, they have said very little of substance—but perhaps I am being slightly unfair, as they said that they would support the agenda for change.
	Opposition Members might like to look at an article in The Times on 24 November—an interview with the hon. Member for South Suffolk (Mr. Yeo)—which says:
	"The Conservative Party put itself on a collision course with doctors and nurses last night by announcing plans to scrap national pay agreements in favour of local hospital deals with staff."
	It continues:
	"The policy has been condemned by the British Medical Association as 'divisive', while the Royal College of Nurses said that it would do nothing to solve recruitment problems."
	The hon. Gentleman insisted:
	"What we want is for hospitals to be able to reflect local conditions and have the freedom to negotiate with their staff. That is one of the characteristics of independence in our view. Clearly the more independence you bestow on an employer, the less scope there is for uniform national contracts."
	Of course the Government appreciate that the Opposition are still tying down certain aspects of their health policy—in fact, most of it—but we had hoped for something more constructive and less muddled from them when they decided on the topic for today's debate.
	The Government are working with patients and staff to deliver real improvements in the NHS for the benefit of everyone. Only the Conservative party does down the NHS, because it does not share our belief that the NHS is the best way to deliver decent health care to everyone in this country. That has always been the case, and we have heard today that, despite all the Conservative party's rhetoric and protestations, it really does not believe in the health service. Not only are 166 Conservative MPs sending out that message, but we now know that a whole gang of prospective parliamentary candidates, highlighted today, are also going out and undermining NHS staff.
	We believe in the NHS, which is why I urge the House to vote against the Opposition motion and for the Government amendment.

Question put, That the original words stand part of the Question:—
	The House divided: Ayes 197, Noes 303.

Question accordingly negatived.
	Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Madam Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
	Resolved,
	That this House welcomes the overall aims of the European Working Time Directive (EWTD) to ensure humane working hours for doctors in training; further welcomes the Government's lobbying of the European Commission and other EU Member States which has resulted in the Commission's giving assurances that they will bring forward legislative proposals on the EWTD before the summer; notes the dramatic reduction in the hours of doctors in training which means that 95 per cent. of them now work for 56 hours or fewer; congratulates the Government on the increases in workforce numbers and medical school places, which mean there are now almost 7,000 more consultants and 55,000 more nurses than there were in 1997, and that 6,030 students entered medical school in England in autumn 2003; welcomes the work being done in the National Health Service in implementing new ways of working that contribute to modernising and improving services and meeting the obligations of the Directive; and joins the Chairman of the BMA's General Practitioners Committee in welcoming the new GP contract as being "better for patients and better for everyone working in general practice" and notes that it will allow primary care trusts to offer patients a safe, high quality service, with care delivered by the most appropriate professional, through better use of more joined-up services.

London

Madam Deputy Speaker: We now come to the second debate on the Opposition motions. Mr. Speaker has selected the amendment in the name of the Prime Minister.

Mark Field: I beg to move,
	That this House takes pride in London's heritage and status as a leading global capital city; notes that its outstanding success over many centuries has depended upon its rich mix of people, innovation and energy; further notes that it is an international leader in financial services, the arts, media, higher education, medicine and scientific research and tourism; regrets that this enviable competitive advantage is now threatened by the diminution in the quality of life of Londoners and those who come to work in the capital; recognises that insecurity brought about by the threat of terrorist action and rising levels of crime and anti-social behaviour, failing public services, overcrowded and unreliable transport, alongside an ever increasing tax burden on all Londoners, will undermine the capital's global reputation as a great place to live and do business; and calls upon the Government and its Mayoral candidate, Ken Livingstone, to address the needs of the people of London and improve the quality and choice of services in the capital.
	London is a global city. Its outstanding success is based on its unique diversity, that rich mix of people, innovation and energy that has served our capital so well over the 2,000 years since its foundation. But today, for the first time in countless generations, there is a clear sense that Londoners' quality of life is not improving and that public services are deteriorating. London's historic position at the centre of the UK's political, commercial and cultural life makes it unusually important, even among leading world cities. Truly, if London fails, the UK fails. When London's economy, culture or entrepreneurial spirit suffers, so, too, does Britain's as a whole.
	However, the continued success of London cannot be taken for granted. Although it faces infrastructure challenges similar to those it faced in the past, those were overcome at various stages throughout its long history. Today's global terrorist threat challenges urban policy makers throughout our nation, as well as across the world. Looking ahead, the Government need to understand the importance of London asserting its commercial competitive advantage not only among its traditional rivals in western Europe or north America, but increasingly in the face of competition from China and India, the two emerging economic powerhouses of the 21st century.
	National politicians, local community leaders and businesses must recognise and embrace the diversity, vitality and energy of our capital. London needs more vision and commercial acumen than has been apparent in recent years. An increasing sense of powerlessness and insecurity is felt by many who live in London, together with a desire for the reassertion of a stronger sense of civic awareness. For although the economy has generally thrived, the overall quality of life for Londoners over the past seven years has not improved. I trust that some of these sentiments will be shared throughout the House. By moving the motion today, the official Opposition call upon the Government and their mayoral candidate Ken Livingstone to address more fully the needs of London's residents, commuters and tourists alike.

Jacqui Lait: My hon. Friend mentioned commuters, and as he knows, my constituency consists largely of commuters. He may also be aware that yesterday the Minister of State, Department for Transport referred to the work being planned for London Bridge and the bottleneck of trains there. Is my hon. Friend aware that the Strategic Rail Authority is threatening to reduce the number of peak hour trains on one line, the Hayes line through Beckenham, by one third, and to dump my commuters at Cannon Street rather than at Charing Cross? What support does my hon. Friend believe my commuters need, and what do the Government need to do to ensure that commuters from Beckenham are able to add to the commercial success of London?

Mark Field: I am only saddened that my hon. Friend thinks her commuters are being dumped from one part of my constituency, Cannon Street, to another, Charing Cross. There are no dumps in the Cities of London and Westminster. However, my hon. Friend makes a valid point, which I am sure will appear in the "Beckenham Evening Advertiser" and various other local papers in the next week or two.
	Today I want to highlight the failings of the Government and London's Mayor in four main areas: crime and disorder, dealing with the threat of terrorist action, transport, and the burden of taxation on London's businesses and residents. Crime and antisocial behaviour are undoubtedly the most critical issues that face London. In every part of the capital it has been confirmed in every survey without exception that too many people, regardless of their background, age or income, do not feel safe on the capital's streets.
	That sense of insecurity is justified by much of the evidence. Crime has continued to increase in the four years since Mayor Livingstone's election. One is more likely to be mugged in London than in New York—19 of London's 32 Metropolitan police boroughs are more dangerous than the notorious Bronx district of New York.

Clive Efford: Is the hon. Gentleman aware that Sir John Stevens has written a note to all mayoral candidates warning them not to misrepresent statistics on crime in London? He highlighted the fact that London is one of the safest regions in the country, according to the latest British crime survey. Is not the hon. Gentleman committing the same crime as his party's mayoral candidate did in the Evening Standard and misrepresenting crime figures in London?

Mark Field: Misrepresentation is a two-way street in this case. One of the statistics in the so-called confidential survey—I understand that it has been leaked to The Guardian today and was not due to be published until next week—makes it plain that when figures for murder and rape are aggregated with those for other assaults in the violent crime category, the picture looks quite good. However, the number of murders and rapes—the more serious violent crimes—has indeed risen over the past four years. Misrepresentation is very much a two-way street.

Clive Efford: The hon. Gentleman is again guilty of misrepresentation. In the Evening Standard, the Conservative mayoral candidate has suggested that crime rates in London are similar to those in New York. The hon. Gentleman referred to murder rates. There are about 1,000 murders a year in New York, but the annual figure has consistently remained at about 200 in London, so the comparison is not consistent.

Mark Field: Let me make it absolutely clear: overall crime rates in London and New York are not comparable, as they are now far worse in London than in New York, mainly as a result of some of the policies about which I shall speak in some detail later.

Simon Hughes: I should like to confirm the point made by the hon. Member for Eltham (Clive Efford). The Metropolitan police are concerned that the Conservative colleague of the hon. Member for Cities of London and Westminster (Mr. Field) is not giving the truth, the whole truth and nothing but the truth about the London crime figures. Representing things as worse than they are and suggesting that crime generally across London is increasing not only fails to represent the accurate position, but adds to fear of crime, which for many people is just as serious as crime itself.

Mark Field: The people of London will have their say on this matter in the next few weeks. Whether or not we have more police on the streets, the message from Londoners is absolutely clear: on crime, Labour has let us down.

Karen Buck: rose—

Mark Field: I give way to my neighbour.

Karen Buck: I am grateful to my neighbour for giving way.
	Has the hon. Gentleman had a chance to look at the civic newspaper of our shared borough, the Conservative-controlled borough of Westminster, which said in March:
	"Efforts are having a positive impact and we are pleased to report that recently released crime statistics show a significant reduction in a number of categories of crime"?

Mark Field: As I said, we will see what people have to say over the next seven weeks, during the course of the campaign.

Andrew Dismore: Will the hon. Gentleman give way?

Mark Field: No; I must make some progress.
	There has to be another way. The Conservative mayoral candidate, Steve Norris, returned yesterday from a four-day trip to New York, where he met Rudolph Giuliani, the former mayor of New York city, who has long observed that it is not headline-grabbing crime rates alone that induce the sense of insecurity to which I have referred. Ironically, it is the physical evidence of antisocial behaviour—the sight of graffiti, vandalism and yobbishness on our streets—that has a much greater influence on quality of life for people in the capital. Indeed, antisocial behaviour is now judged to be worse in London than in any other city in the UK.
	Paradoxically, the amount spent on policing has never been greater. I accept that, and I also appreciate that we now have some 30,000 uniformed police officers and community support officers here in the capital—the highest number ever. While the costs of policing have escalated to almost £3 billion a year, however, there has been no corresponding reduction in the fear of becoming a victim of crime here in the capital. Detection rates have also fallen to below 15 per cent., after a sustained fall since six years ago, when detection stood at roughly one quarter.
	Many of Steve Norris's ideas and recommendations challenge contemporary assumptions about the nature of policing in the UK, and we as Conservatives promise Londoners that under a Tory Mayor, starting on 11 June, there will be a fundamental change in the management and organisation of the police here in the capital.

Eric Forth: On that very theme, I hope that my hon. Friend can also reassure those in the outer London boroughs such as Bromley that full attention will be paid to their concerns. Although the overall number of police officers in the metropolitan area may well have increased—we must all welcome that—in my borough of Bromley, the number of police officers is still fewer than in 1997. I therefore hope that we will get a pledge from our mayoral candidate, and indeed from my hon. Friend, that under a Conservative administration and Mayor, the outer London boroughs would receive full and proper attention.

Mark Field: I entirely agree with my right hon. Friend. The threat of terrorism has increased in my central London constituency, and the number of uniformed police officers has inevitably increased, in my patch above all, since 11 September 2001. The price has had to be paid in the suburbs, which are represented by hon. Members on both sides of the House, and the Conservative mayoral candidate will emphasise that point.

John Randall: Although terrorist targets are in the centre of London, terrorist suspects are being picked up in the suburbs.

Mark Field: I entirely accept that point. My hon. Friend represents part of Heathrow airport, although I understand that most terrorist suspects are moved across to Paddington Green police station before too long.
	One arm of the Government is often blissfully unaware what the other arm is doing. For example, the Department for Culture, Media and Sport saw the Licensing Act 2003 as encouraging all-night activity on our city streets. The widespread deregulation of pubs and other licensed premises was supposed to herald a 24-hour city culture, yet at the same time the Home Office has made much of its eye-catching initiatives, which are, in the main, failures, to clamp down on antisocial behaviour. Do the Government recognise that drunken loutishness and disturbance has skyrocketed as a result of their failure to provide effective policing on the streets in the early hours, along with round the clock public transport to ferry all-night drinkers back to their homes? Many London residents have had their lives turned into hell, not only in the west end in my constituency but in places such as Croydon, Ealing and Romford, and they recognise that Labour has let them down.
	From the fate that befell Spain last month, it is clear that the threat of global terrorism is serious and imminent, and nowhere more so than here in the capital. However, the Government strategy appears to be to wait for what they regard as an "inevitable attack" and then—and only then—to act. That cannot be the right way forward. The public have been told almost nothing about the nature of the terrorist threat. There has been virtually no formal training, and the emergency services here in London would be stretched in trying to deal with the aftermath of a major incident.
	The Home Secretary has spent much of the past two and a half years introducing an array of new laws to the statute book, undermining many of this country's traditional freedoms. At the same time, he has by his own admission lost control of the immigration system to the extent that tens of thousands of people find their way illegally into this country every year and simply go underground, out of sight of the security services.

Diane Abbott: Is the hon. Gentleman seriously suggesting that the Government have adopted a wait and see policy on the terrorist threat, when exercises have been conducted and money has been spent? The efforts of the Mayor, Ministers and the Metropolitan police cannot be described as a "wait and see policy". That is an insult to dedicated professionals.

Mark Field: It is not an insult. The single exercise was delayed by some six months, and training has been insufficient. Meanwhile, most people take the view, which was recently expressed by the Metropolitan Police Commissioner, that an attack is inevitable.

Andrew Dismore: I am bemused, because at a recent meeting Sir John Stevens said that one in 10 London police officers are now engaged in some form of anti-terrorism work, and we also have 200 extra firefighters specifically for that purpose. Are those not proper preparations?

Mark Field: The hon. Gentleman fails to understand that it is a question of educating the public. Perhaps 3,000 police are engaged in anti-terrorist activity, but we must educate the public at large, including tourists and people who work in London. In that regard, the policy has been little more than wait and see, and the Government have failed.

John McDonnell: Today's Metro London reports an alleged threat to Heathrow airport, and the hon. Member for Uxbridge (Mr. Randall) and I have attended all-party meetings with the Minister to discuss security at Heathrow. We came away reassured about the intensity of the co-operation between Government, Mayor, Metropolitan police and BAA about security arrangements at Heathrow. Indeed, a number of exercises and reports have identified individual problems that have been addressed, even to the point of putting tanks around Heathrow on that occasion. We engage in knockabout when we speak, but it is important to reassure people that Heathrow airport is the safest in the world.

Mark Field: I appreciate that. Equally, however, there is a distinction between reassurance and complacency, and we must not be complacent about the fact that it may be at risk.

Andrew Dismore: Will the hon. Gentleman give way?

Mark Field: No, I must make some progress.
	At the same time as the Home Secretary has lost control of the immigration system, we have pressed the Government to build up a proper civil contingency reaction force here in London. Although London is the prime UK terrorist target, it is massively short of such a capability and heavily reliant on Territorial Army reservists. And where is the main London TA regiment today? Many of those brave reservists find themselves on duty in Iraq, doing incredibly worthwhile work in Basra—probably during the past 24 hours, given the horrendous events that have taken place. Nevertheless, they leave an enormous gap in London's protective cover.
	The Government need to instil confidence in those who live, work and travel to London and more—much more—needs to be done to keep the terrible threat posed by those tenacious terrorists at bay.

Linda Perham: Will the hon. Gentleman give way?

Mark Field: No, I must make some progress, if the hon. Lady will excuse me.
	All too often, the Government talk big about their resolve in the face of terrorism, but pass the responsibility to local authorities without adequate financial resource for contingency, resilience and emergency planning.
	Labour has let Londoners down on public transport, which has become ever more overcrowded and unreliable than in May 1997, when the newly elected Government launched with a great fanfare their now defunct 10-year transport strategy. Their continued refusal to fund Crossrail is not simply a London but a national disgrace.
	On the whole, then, the Government's has been rather a dismal performance; but Mayor Livingstone, the Labour party's candidate this June, has an even more threadbare record. In his four years as Mayor, he has wasted millions of pounds of Londoners' money on suing the Government in a futile attempt to block the public-private partnership on the London underground. That has resulted in his first term being characterised by the continued rapid deterioration in the capital's tube without any strategy for future investment. At the same time, he has struck a Faustian bargain with Bob Crow and the extremist RMT trade union, which has sought, through repeated industrial action on the tube—I fear that Londoners will see more of that in the hot summer months ahead—to hold London's businesses, commuters and residents to ransom.
	There is a widely held myth that the Mayor has been responsible for a fabulously successful transport policy. It is certainly the case that the congestion charge in central London, which was introduced in February 2003, did not lead to the riots on the streets that many might have predicted. However, it is costing immeasurably more to administer than it is bringing in in revenue. Initial projections suggested that Livingstone's tax on London's car owners would raise some £200 million in annual revenues, which Londoners were assured would be invested in improvements to the transport infrastructure in the capital. Instead, in its first full year of operation, the congestion charge has barely broken even, while serious doubts are emerging as to the efficiency with which fines for those who flout the charge are being enforced.

Kate Hoey: I agree with aspects of the hon. Gentleman's remarks about congestion charging, but his own borough of Westminster has not been very pro-car either. Its parking enforcements have been badly handled—so much so that even I had my Mini carried away the other night. It was taken by the rudest possible people, who, when I tried to reason with them because they were towing me away illegally, behaved in a manner that was very unworthy of Westminster council, as I am sure the hon. Gentleman will want to agree.

Mark Field: I am tempted to emulate my party leader and turn to song. Certainly, I used to like the Beach Boys until earlier this afternoon. Traffic enforcement is not in the hands of Westminster council alone—some of it is hived off. The phrase, "God Only Knows" comes to mind.
	In short, the congestion charge is probably unique as the only tax in history that will actually lose money. As for its effect on retail business within the zone, even the Mayor's office will not dispute that it is proving extremely arduous, especially on many small family-run businesses—not, I hasten to add, that it has any great fans among retailers in Oxford street or the Strand. Meanwhile, the Mayor's obsession with subsidising the buses is becoming a financial nightmare, which will cost Londoners dear in further sharply increased council tax bills in the next five years.
	Let us consider the cost of Livingstone.

Harry Cohen: Will the hon. Gentleman give way?

Mark Field: No, I want to make some progress.
	Before the Government try to wash their hands of responsibility for the actions of their preferred mayoral candidate, Londoners should be reminded that the additional layer of London government bureaucracy is a consequence of Labour's election in 1997.
	In Ken Livingstone's first full term as Mayor, the Greater London authority precept has risen by an inflation-busting 96 per cent. from £123 for each band D taxpayer in 2000 to the current £241 per annum. What has he done with all the money? It is true that some has gone towards bolstering police numbers in London but no less than £1.5 million a year goes on employing some 19 press officers at City hall. We all thought that the Prime Minister was spin obsessed, but the Mayor spends even more on his propaganda machine. That is before we count the £3.8 million cost of Livingstone's newspaper The Londoner, which tells the few London residents who bother to read it what a wonderful job Comrade Ken does on their behalf.

Andrew Dismore: The hon. Gentleman complains about the rises in the precept and says that a small amount has been spent on policing. However, 79 per cent. of the precept increase has been spent on policing London. There are big adverts on behalf of Mr. Jarvis—sorry, Mr. Norris—the Tory candidate for Mayor. How will he fund his proposals for policing without that sort of expenditure on it?

Mark Field: He has made it clear that it is not simply a question of police numbers but managing and organising the police. That shows the main difference between the two main parties on policing. We shall hear far more about that in the next few weeks of the campaign.
	The Mayor has also committed Londoners to paying an additional £20 a year over 12 years to fund the Olympics should the United Kingdom bid be successful. However, as if the cost of providing the Government with a blank cheque for any financial overrun on the Olympics was not bad enough, the biggest black hole appears in the transport account.
	According to the Mayor's figures, there is a funding gap of £1 billion a year from the next financial year onwards between what he wants to spend on buses and the aggregated predicted Government grant and all other income sources. The message to Londoners should be clear: more Ken after 10 June will mean more tax from the Prime Minister's hand-picked candidate for Mayor of London.
	There are only two reasons for the Government's readmittance of such an inappropriate mayoral candidate to the Labour party. Neither has anything to do with his abilities as London's political figurehead. First, if Ken Livingstone had run as an independent, the official Labour candidate would have been humiliated by coming at best fourth in the mayoral race. Secondly, the split in the Labour vote that his running as an independent would cause was likely to damage many of Labour's Greater London authority candidates, with potentially damaging consequences for Labour in the capital in the next general election.
	Surely the Government's failure to grasp the nettle of policy making in the capital cannot be summed up better than by their cynical readmittance of Ken Livingstone to Labour's ranks. From his vulgar criticism of the United States President, the Saudi royal family and the democratically elected Prime Minister of Israel, the Mayor's penchant for grandstanding to extremist opinion does great damage to London's reputation. Although he is often portrayed as a cheeky chappie and an anti-establishment figure, Livingstone is surely not the right voice for London.
	The mayoralty is an important public role, which is key to promoting London tourism and business throughout the globe. It also involves a budgetary responsibility of some £7.5 billion a year. Londoners deserve better than someone who, in his demeanour and outbursts, often appears better suited to student union politics. Perhaps that would matter little if the Government did not pass directly to him millions of pounds of annual grant, through the London Development Agency, earmarked for promoting tourism and business in places such as the United States and the middle east. Once more, the Labour Government are letting Londoners down.
	I appreciate that many other hon. Members want to contribute to this important debate, but I wish to conclude with a few thoughts about the way in which we might improve our quality of life in our city. The rapid pace of change in life in London will only increase in the years ahead and that will doubtless leave many fearful about the effects of globalisation. I represent a most central inner-London seat—I appreciate that it always raises a wry smile from Labour Members when I refer to my inner-city credentials. However, although Mayfair and Knightsbridge may not be typical inner-city areas, parts of Bayswater, Pimlico and Victoria most certainly are. I find that the desire for security and a sense of urban identity and belonging is even stronger among the residents in my most built-up urban communities. Twenty or so residents' associations and amenity societies thrive in my constituency alone, and I have observed, especially in the last couple of years, how the membership and activity of those bodies has increased. They recognise the importance of preserving historic buildings and of good aesthetic design to their sense of security and well-being.
	In dealing with inner-city affairs, the voices of reaction—especially, it has to be said, in my own Conservative party—often hark back to a golden age. I believe, however, that all of us in London who have a passion for our city need to be practical. The real issue is not "Globalisation, yes or no?" but how we can develop, reform and reinvigorate our urban institutions to secure the enduring values of our traditions. In London, we need to resist the temptation to reverse the tide and simply recall how much better life might have been in the past. Instead, we must be optimistic and energetic about life in cities, and adapt to the often exciting, modern globalised world in which we now live.
	One of my own local authorities, Westminster city council, has played a leading role in its civic renewal initiative in developing partnerships between residents, police and Government agencies in improving the quality of life of those who live and do business in central London. Its key insight has been to break down the perhaps false dichotomy that has existed in urban policy making between the top-down versus bottom-up analysis of civic participation. It is only right to recognise that, in several of these localised initiatives here in Westminster, the Government have played an important part in providing both financial resource and legislation for projects such as the business improvement districts, which are already making a significant impact in revitalising the west end as a retail centre.
	However, many people in London feel a vague yet uncomfortable state of disconnectedness from the political process. The issues of civic renewal and the restoring and revitalising of community institutions to facilitate a renewed public engagement in our capital go beyond the realms of this debate, but I hope that London Members here will play a part in developing an agenda to improve the quality of living in the capital. I certainly plan to do so.
	I love cities, especially my own. Like so many young adults, I chose to come to London, and now consider myself to be one of her sons. The challenge ahead is to make London liveable for its residents and sustainable as a leading global commercial centre. I call on the Minister to assure me that this Government share the vision of what London can and should be. I also ask him to put pressure on his colleagues, in particular the Chancellor of the Exchequer and the Mayor of London, to set their sights on improving the quality of life here. Londoners feel let down by this Government, and London deserves better.

Keith Hill: I beg to move, To leave out from "tourism" to the end of the Question, and to add instead thereof:
	"welcomes the Government's commitment to London's continuing economic, social and cultural success, and to enhancing its status as a world class city; applauds London's high levels of productivity and success in attracting inward investment that benefits the whole of the UK; recognises that this success is backed by record levels of funding from this Government for education, health, the arts, culture, creative industries, crime prevention, transport and other key public services that have resulted in substantially higher employment, substantially lower unemployment, record police numbers including more community support officers and police on the beat, massive increases in bus services and people using them, with an extra 100 million bus trips and an extra 180 million tube journeys taken a year; applauds the leadership of the Mayor of London, working in partnership with the Government in the key areas of transport, planning, economic development and policing; praises the work of the police and security services in remaining vigilant to keep the capital safe; and condemns outright Opposition attempts to talk down and undermine the continued success of our great capital city."
	I congratulate the hon. Member for Cities of London and Westminster (Mr. Field) on what I believe is his maiden appearance at the Dispatch Box. Personally, I thought that he carried it off rather well. His speech was a minor triumph of style over content. I must remind him that he was speaking to a motion and that words are generally supposed to have meaning. The words of this motion are a farrago of nonsense. They talk down our great city, sell London short and deliberately fail to recognise the huge progress made in London in recent years as a result of the excellent work and co-operation between this Labour Government and our Labour Mayor and Labour Assembly Members. That is why I have to advise my hon. Friends to vote against the motion.
	Let us look at the motion in more detail. It claims that London's "enviable competitive advantage" is now under threat. What world are the Tories living in? London is a great world city with world-class cultural and sporting resources, world-class universities and a business community that is a key engine of national economic growth. London is renowned for innovation, entrepreneurship, style and dynamism. More than 300 languages are spoken here, reflecting the wonderful diversity and strength of our population. London has more than 200 theatres, 125 dance companies and 395 public libraries. That incredible social and cultural diversity draws skilled workers from all over the world.

Andrew Dismore: Will my right hon. Friend give way?

Keith Hill: Of course I will give way to my hon. Friend, but I must warn hon. Members that, if they will forgive me, I do not intend to take many interventions. In these short debates, it is important that as many Members as possible have the opportunity to speak. I personally aim to speak for not more than 20 minutes.

Andrew Dismore: I very much agree with what my right hon. Friend says about the diverse nature of our city. Can he comment on the views expressed in our local newspapers by Councillor Brian Coleman, a GLA Member for Barnet and Camden, about Middlesex university? He described it with a four-letter word beginning with c because it accepted so many foreign students.

Keith Hill: To be honest, I was not aware of that. I am pleased that I was not aware of such a nauseating comment and wholeheartedly condemn those sentiments, in which I am sure that all decent Members join me.
	London's huge economic dynamism means that inner London is by far the richest region of the European Union, with a GDP per head of 260 per cent. of the European Union average. Ten years ago, under the Tories, the per capita GDP of London was less than £12,000. Now, under Labour, it is more than £19,000. In 1992, under the Tories, unemployment in London stood at more than 780,000. Now, under Labour, it is down to 450,000. Since Labour came to power in 1997, unemployment has fallen by more than 40 per cent.
	Contrary to Tory claims, London provides a highly competitive environment that encourages innovation and experiment. Its productivity levels are 25 per cent. higher than the national average and closer to American levels than to UK or average European Union levels. London acts as the main gateway for international investment. It is one of the world's top three financial centres, alongside New York and Tokyo, and is by far the largest in Europe. It accounts for 31 per cent. of global foreign exchange turnover, and 48 per cent. of world turnover in foreign equities trading. London's attractiveness to foreign firms is demonstrated by the fact that it has 447 foreign banks—more than any other city in the world.
	The motion refers to an "ever increasing tax burden". What on earth can the hon. Member for Cities of London and Westminster mean? There is not a shred of evidence to suggest that London is taxed more heavily than anywhere else in the UK. It is perfectly true that it is enormously prosperous and successful and that its success contributes to the prosperity of the UK as a whole. As a result of that success, it is, of course, a net contributor to the Exchequer, together with the wider south-east, with the amount estimated at between £7 billion and £17 billion each year. That is an interesting fact to which many of my London colleagues, including Ken Livingstone—and, indeed, myself—have been known to draw attention from time to time. That net contribution is a consequence of our progressive taxation system, in which the wealthy contribute proportionately more than the poor. We make no apology for that: we are the party of the many, not the few. To set the record straight, I ought to point out that, because of London's needs, public spending in London is among the highest of all UK regions, at 1.2 times the UK average and, in transport, it is 2.75 times the UK average.
	In his motion, the hon. Gentleman draws attention to the shortcomings of London's transport system and it would be a foolish politician who sought to deny the stresses and strains of a public transport system that has suffered decades of under-investment and is now striving to cope with the consequences of economic success. But it is pretty rich for a Conservative politician to attempt to lay the blame for London's transport problems on this Government and this London Mayor. Between 1992 and 1997, it was the Conservative party in government that slashed capital investment in London's tube system by no less than half, cutting it massively from £700 million a year to £350 million. It is this Labour Government who are investing £1 billion a year in London's underground system under the public-private partnership, a programme that over the next 15 years will deliver a tube system that is more efficient, more reliable and fit for the 21st century, with, at last, "a decently modern metro", for an underground system that carried almost a billion passengers last year.
	This Labour Government have worked with the Mayor to secure a transformation in London's bus services. Since 2000, the Government have more than doubled Transport for London's budget, which has risen from £1.2 billion in 2000–01 to over £2.5 billion in 2003–04. As a result, London bus occupancy is now twice the level of that in other English metropolitan areas, bus use has increased by 30 per cent. since 2000, bus mileage is higher than at any time in 40 years and public satisfaction with London's bus services is at the highest level ever recorded.
	I understand that the Liberal Democrat mayoral candidate plans to cut those services. I pay full tribute to Ken Livingstone for his clear recognition that only through a rapid expansion of bus services could London's immediate transport needs be met. I congratulate him on what he has achieved in the past three years in improving London's bus network.

Simon Hughes: rose—

Keith Hill: I will not give way to the hon. Gentleman. I am certain that he will have his chance to speak and, if I know anything about the hon. Gentleman, he will explain himself at considerable length.
	The work that we have done on London's bus network is another excellent example of Whitehall and City hall working together. I also pay full tribute to the Mayor for his courage and vision in introducing the congestion charge, which has been an outstanding success.

Eric Forth: On a point of order, Madam Deputy Speaker. Is it in order for the Minister, of all people, to cite the alleged brevity of his speech as an excuse to take no interventions? Surely the whole point of a debate in this Chamber is to allow an exchange of views. Is there anything you can do to protect us from a Minister who will not take part in a debate?

Madam Deputy Speaker: The content of the Minister's speech, as with any Member's speech, is his responsibility. He is addressing the motion.

Keith Hill: I should love to take an intervention from the right hon. Gentleman. I did not take one from the Liberal Democrat mayoral candidate because I was sure that he would have his own chance to speak at considerable length in due course.

Jacqui Lait: rose—

Keith Hill: Of course I give way to the hon. Lady.

Jacqui Lait: I thought for a moment that the Minister might have taken me for a Liberal Democrat because I am wearing a yellow jacket. Before he leaves the subject of transport, could he explain why there is a threat of delay to the extension of the east London line?

Keith Hill: I am not an expert on these matters, although as a south London Member I take an interest in them. There are complicated issues relating to both the investment and the alignment of the east London line that I understand are, at least for the time being, impeding further development.
	I was paying full tribute to the Mayor for his introduction of congestion charging. As a result of that, congestion in the zone is down by 30 per cent., at its lowest level since the 1980s. There is evidence of a faster reduction in road traffic accidents inside the zone than outside and of a reduction in air pollution as a consequence of the reduction in traffic emissions. The charge is an innovation that has inspired interest and admiration throughout the world, and the support of most Londoners.
	While I am in the tribute business, let me also acknowledge the excellent co-operation between the Government and the Mayor in increasing police numbers. In its motion, the Conservative party has the gall to talk of
	"rising levels of crime and anti-social behaviour".
	Yet this is the party that, between 1992 and 1997, when its current leader was Home Secretary, presided over a decline of well over 1,000 in London police numbers, which fell to 26,500. Now, under the Prime Minister and Ken Livingstone, the Metropolitan police service stands at over 30,000 officers—a record number—and 3,500 of them are funded by the Mayor's budget. The step change programme aims to increase the service to 35,000 officers over the next four years.

Kate Hoey: I thank my hon. Friend and colleague in the London borough of Lambeth for giving way. Everyone in Lambeth welcomes the extra policing in the borough, but does he agree—I am sure that he has been made aware of this in recent meetings with residents' and tenants' associations—that a problem is posed by the number of our local community beat officers who are being moved to central London to guard this and other areas because of the terrorist threat? It is very important that people living in boroughs such as ours are adequately policed despite the terrorist threat and that there should never be hardly any community beat officers in Lambeth, as sometimes happens.

Keith Hill: As my hon. Friend and fellow Lambeth Member knows, we are absolutely at our full complement and establishment of police officers in Lambeth, and both our constituencies benefit extensively from the presence of community support officers, but she is right that there is a strain on police resources as a result of the terrorist threat. That is exactly why the step change programme, which promises to increase the Met's numbers to 35,000 over the next four years, is so critical.
	Since 2001, there are 1,000 more police officers on the beat and the Home Office has joint-funded with the Mayor 1,000 police community support officers to provide visible reassurance to Londoners at a time of heightened concerns about terrorist attack. My hon. Friend the Minister for Crime Reduction, Policing and Community Safety will talk more about action against the terrorist threat in due course.
	Contrary to the Tory claims, crime rates in London are falling. We have had a 20 per cent. reduction in reported street robberies over the past 12 months. In autumn 2003, burglary in London was at its lowest for 25 years, street crime is down by a third and reported burglary at a 27-year low. Frankly, that is better than New York, so Steve Norris can save the London taxpayer the expense of importing ex-Mayor Giuliani. We have been there, done that and got the T-shirt.
	Londoners know, contrary to the assertions of the official Opposition spokesman, that London is a safer city to live in. As MORI's annual London survey shows, the fear of crime is down across a range of indicators.
	Londoners also recognise the significant improvements in their public services. In education, since 1997, there has been a real-terms funding increase of £900 per pupil in London's schools and capital investment is up from £81 million in 1997 to more than £500 million today. There are 4,100 extra teachers and 13,200 additional support staff across London. Results in London at primary school level have improved dramatically, with 75 per cent. and 71 per cent. now getting to the required standard in English and Maths—still too low, but a vast improvement—and a rise in GCSE results from 40 per cent. to 49 per cent. achieving five good passes, which is a faster improvement than in the rest of the country. I pay tribute to the Education Minister, my hon. Friend the Member for Enfield, Southgate (Mr. Twigg) for his work on the London challenge with London's most hard-pressed secondary schools.
	In the national health service in London, funding increased from £6 billion to £7 billion in just one year, 2002–03—part of a £4 billion increase between 1997 and 2003. Nearly £4 billion is being invested to redevelop and build brand-new hospitals across London. In 2002, there were 2,500 more nurses than a year before, and 350 more GPs in London compared with 1997. Waiting lists for in-patient and out-patient treatment in London have fallen in leaps and bounds.
	I am a resident of London and a London Member, as well as the Minister for London, so of course I recognise that London is a city of contrasts between great wealth and, in some areas of our capital city, unacceptable levels of deprivation, but let us be clear: the step change in funding for public services in London since 1997 is bringing huge benefits to London's deprived communities. In addition, 20 London boroughs are covered by local strategic partnerships, supported by more than £400 million of neighbourhood renewal fund resources in the current five years up to 2006. Furthermore, 10 of the Government's 39 flagship new deal for communities partnerships are sited in London boroughs, with access to a collective 10-year budget of more than £525 million to tackle the problems of London's most deprived communities. Yes, the need is great, but so are the resources that this Government are deploying to tackle that need.

Harry Cohen: Picking up on that point, and the point about education that my right hon. Friend made earlier, is he aware that one of the most serious problems for Londoners is the skills gap? Many people in the deprived communities that he has just mentioned need training to be able to get jobs. The Conservatives say that they will match Labour's spending on schools, but not on education as a whole. Surely that would mean a catastrophic cut in skills training programmes, which is just what London and Londoners do not need.

Keith Hill: My hon. Friend is right. The Conservatives claim to have the objectives, but it is also essential to build the means. That is why our work with the London Development Agency and the business community on developing schools and our recent announcement on maintenance allowances for post-16s are so essential to build up those skills in London's work force and population.
	Through the Mayor and the London Assembly, this Government gave back to London and Londoners a strong voice and restored democratic city-wide government and strategic leadership to the capital. Ken Livingstone and the London Assembly have achieved much, including the successful introduction of congestion charging, more police on the streets and an increase in bus use. They have worked with Londoners to develop strategies to improve London's environment and cultural facilities and to promote London for business and tourism.
	The fact is that London is, and will remain, a great city. We have much to be proud of and we will not have our reputation debased by Tory smears. We know that the picture is not perfect and that is why the Government are working with the Mayor, local authorities and others to reverse the legacy of chronic underinvestment in our public services. Improving public services lies at the heart of Londoners' needs and concerns. That is why we are providing big extra funding for health and education and working with the Mayor to improve public transport and the fight against crime. We want to ensure that all Londoners, not least those in our most deprived communities, share a better future and quality of life.
	The Government will continue to work to maintain the economic growth and stability, high levels of employment and increased public funding that will ensure a better future for all in London. This Labour Government will take that work forward with Ken Livingstone, our Labour Mayor, for many years to come. The Prime Minister and London's Labour Mayor will stand shoulder to shoulder, delivering for London.

Simon Hughes: Little would we have expected a year ago to hear that ending.
	My party welcomes the debate. When the Conservatives were in power, they were no good at integrated transport, but they would probably regard today as the peak of integrated campaigning. They get their mayoral candidate off to New York for the weekend, they manage to unveil a poster, they put an advert in the evening paper and they hold a debate in the House of Commons. The only trouble is that the premise of their argument about crime is fundamentally flawed, which is rather a pity. However, it is good that we are debating London. As the hon. Member for Cities of London and Westminster (Mr. Field) said, this is a great city.

Stephen Pound: He did not say that.

Simon Hughes: He did say that. It is a great city, and my party shares that view, although we believe that it could be greater still.
	I suppose that I must declare a sort of interest. In a couple of weeks' time when the election campaign starts for the London Mayor and Assembly, I might turn from being a prospective candidate in that election into being a candidate; if so, I shall be very—

Iain Coleman: Will the hon. Gentleman give way?

Simon Hughes: No, not yet. If that transition occurs, I shall be very proud.
	I wish to start by establishing the points of agreement. The first part of the Conservative motion is not altered by the Labour amendment or by ours. We all recognise the common values and benefits of this great city: its mix of people, its enterprise, its history, its culture and its diversity. We all share those values, whether we were born here, have moved here, work here or visit here. We would all want to enhance, applaud, welcome and celebrate that.
	Like the Labour party, we seek to amend the motion. Most fundamentally, we say that, although London has huge needs and problems, we must be careful not to talk it down. My fundamental complaint about the text and texture of the otherwise good speech of the hon. Member for Cities of London and Westminster—and it applies to his Conservative colleague who is standing in the election—is the danger of talking London down. I always try not to do that, whatever the criticisms, and I hope that my colleagues do not do so either.
	I would go further and acknowledge that the reinstated London government and the first, now outgoing, Mayor have done good things for London. Indeed, I have said that to his face. We accepted that congestion charging was a bold and good initiative, and my hon. Friends and I supported it from the outset in Committee and we have continued to support it throughout. We are also glad that the Mayor came round to endorsing the Olympic bid. Some of us argued for it earlier, but he came on board, and we welcome it. We are pleased that there are more buses, although the Minister would not allow me to intervene earlier and it was clear that he was unwilling to answer questions about how they would be paid for. The Mayor has not answered those questions either.

Iain Coleman: rose—

Simon Hughes: If the hon. Gentleman can be a little more patient, I will give way in a minute.
	We also supported the increased policing—not hugely different from comparable increases in policing in Greater Manchester and other parts of the country—in London. After an initial couple of years without any increases, the Labour government came to realise that increases were necessary. We support that. If my Liberal Democrat colleague had been Mayor over the past four years, she would have done the same—so there is some common ground.
	The political history of the past 20 or 30 years is of the Greater London council—first Tory-led, then Labour-led—its abolition by the Tory Government, the Government Office for London under Conservative and Labour control and then the first directly elected Mayor. There has been a history of underfunding, for which the Conservatives should accept significant responsibility, and some fundamental problems.
	I shall not make a single quote from any document produced by any political party, and I shall be brief on statistics as it would be possible to quote statistics about London for hours. As the Minister for London will know, the Cabinet Office produced its analytical report on London last July. Its executive summary stated that London
	"has high numbers of jobless people and substantial deprivation . . . has a housing market which is under strain and which will come under increasing pressure . . . has a transport infrastructure that has not kept step with the city's developing needs in the last fifty years . . . has public services that face substantial challenges as a result of the city's unique characteristics . . . has a complex system of governance"—
	the one set up by the Government—
	"that does not easily enable the city to focus on its strategic needs."
	When the cross-party Association of London Government surveyed Londoners last autumn, it asked them about their biggest concerns. Crime was at the top; council tax was second; the health service was third; traffic was fourth; and education was fifth. Interestingly, the survey showed that the one concern that had increased was the level of council tax. In common with the hon. Member for Cities of London and Westminster, I have no doubt that the Mayor of London is responsible for significantly increasing council tax. The increase over the past four years has been huge—greater than in any other authority in England. It is in the order of a 100 per cent. increase, for which the Mayor alone must take responsibility.
	Surveys are conducted every year on the quality of life in world cities. This year's survey was produced in March. London was 35th in the league table for world cities and only 11th out of 15 European Union capitals. The Greater London Authority commissioned another interesting survey—again, one that was not influenced or instructed by my party colleagues. A comparison was made between 2000 and 2003 and respondents were asked how satisfied or dissatisfied they were with their neighbourhood as a place to live. What was the change in the satisfaction level? The number of people either totally or fairly satisfied had decreased—not significantly, but it had gone down—in those four years from 83 to 78 per cent. The dissatisfaction level has gone up. When people are asked how satisfied or dissatisfied they are with London as a city to live in, the satisfaction level has fallen from 75 per cent. to 71 per cent., and the dissatisfaction level has increased. The legacy of the four-year mayoral term of the initially independent and now newly new Labour Mayor is that Londoners are not as happy with their lot as they were when he started. He has to take responsibility for that.
	One of the key issues is how much money comes into the city. Private enterprise does a huge amount: we are the world's greatest financial centre and we need to continue to be so. As we pointed out in our amendment, we need to have a debate about how much London should contribute to the UK and how much the Government should give to London. I have never argued, in all my time in Parliament, that London should not make a contribution to the rest of the UK. However, there is a case to be made—and all parties submitted their case for London to the Government as part of the comprehensive spending review—that the balance is not right. My party's leader and other colleagues have accepted that we need to renegotiate the UK constitutional financial settlement, post devolution to Scotland and Wales, given the continuing devolution that we hope to see to Northern Ireland, and with regional government on the way in England.
	The ballpark figure for the net contribution to the UK economy from London is some £17 billion. The figure should be between nothing and that figure—probably about half. However, nobody suggests that London should not continue to contribute, as a capital city properly should, to the rest of the country.
	We have one major disagreement in this area with the current Mayor. He appears to think that all development that wants to come to London and the south-east should be encouraged to do so without let or hindrance. The north-east, the north-west, Scotland and Northern Ireland are crying out for investment, so we need to share the pressure of development. That is why, for example, my hon. Friends the Members for Kingston and Surbiton (Mr. Davey) and for Twickenham (Dr. Cable) have argued for the spreading of the civil service around the UK. That would make some contribution to the economies of the other regions. It is not inconsistent to want the regions to have healthy economies and to want a strong capital city.
	We do not need the levels of council tax increase that the Mayor has imposed on Londoners. For example, my colleagues took over the running of the London borough of Southwark from the Labour party two years ago. Services have hugely improved—as all the MORI polls in Southwark show—on a council tax increase of 3.5 per cent. this year. Increases of 22 per cent., 15 per cent., 29 per cent. and 8 per cent.—as imposed by the GLA—are not necessary. Improvements can be made more cheaply.

Karen Buck: Will the hon. Gentleman give way?

Simon Hughes: I greatly respect the hon. Lady's contribution in London and I will give way in a moment. However, I first wish to give a couple of examples of how money could be saved.
	City hall now has more people running its press operation than does Downing street, and that is clearly mad and unjustifiable. On new year's eve, for the first time in four years, we had a London celebration, of a sort. After nothing for three years, we had a £1 million firework display. It was paid for from public funds and had no private sector sponsorship. In theory, it was supposed to last for three minutes, but in reality it was less. However, as I know from chairing the Thames festival, one can get a much longer and better firework display for a quarter of that sum. It could also probably have been entirely funded from private sponsorship. The Mayor just does not understand that the money he spends is that of many hard-pressed Londoners, not his. We would do things very differently.

Karen Buck: The hon. Gentleman mentioned services in Southwark. Will he comment on the fact that in both Southwark and Islington services for children—in particular, nurseries—have borne the brunt of major spending cuts, in contravention of the Government's programme to expand child care places? It cannot be claimed that services have been improved and enhanced across the board, as the hon. Gentleman implies.

Simon Hughes: I am happy to debate that point with the hon. Lady at another time and place—[Hon. Members: "Oh!"] No, I deny that spending on children's services and the quality of those services in Southwark have been cut. I do not think that that is true. I know less about Islington, but I can check. I doubt that it is true in that case either. The hon. Lady knows, from both the boroughs that she represents, that when councils are under severe pressure to keep council tax increases to the low single digits, the pressures are enormous. That is why she supported, as I did, the case for London that would give a better funding settlement to all our local authorities. Of course we want more money, including for social services, and I shall join her in arguing that case both for children and the elderly. When we took over in Southwark, we moved a lot of money in the social services budget to children's services because they had been badly underfunded, according to the Audit Commission, when Labour was in control.

Iain Coleman: Will the hon. Gentleman give way?

Simon Hughes: I said that I would give way, and I will.

Iain Coleman: I grateful to the hon. Gentleman for giving way. May I take him back to 29 January this year, when he told the Jon Gaunt radio programme that, by April—that is, now—he would be second in the polls and closing very quickly on the Mayor? In fact, of course, a further poll taken since shows that he is five points down and 30 percentage points behind the Mayor, who currently has 46 per cent. compared with his 16 per cent. Will he now answer the question that he has consistently refused to answer when asked on the Frost programme and in many other interviews? As it is obvious to anyone who reads any of the polls that he has absolutely no chance whatsoever of winning the mayoral election, what will he advise—

Mr. Deputy Speaker: Order. The hon. Gentleman has had a long run on an intervention. I am tempted to tell him to ask the question that he was allowed to put, briefly.

Iain Coleman: Thank you, Mr. Deputy Speaker. I apologise.
	Will the hon. Gentleman now advise the House what he will tell the few supporters whom he will get on 10 June what they should do with their second vote?

Simon Hughes: On the first half of the hon. Gentleman's long question, I advise him to remember what happened in Brent last autumn and in Bermondsey some years ago—both of which were Labour-held seats. [Interruption.]

Mr. Deputy Speaker: Order. The hon. Member for Brent, East (Sarah Teather) should behave herself properly in the Chamber, and not in that manner. She should apologise to the House for what she was doing.

Sarah Teather: I apologise to the House; it was very inappropriate.

Simon Hughes: I remind the hon. Gentleman to look at the history of Liberal Democrats frequently overtaking the Conservatives and beating Labour. I will happily talk to him about the result on 11 June.
	On the second issue, my advice is for people to give us their first preference, and they can choose what they do with their second preference. I hope that the Labour party and others give exactly the same advice to their voters.
	Crime and security are hugely important issues. First, I join the Government in the words in their amendment that pay tribute to our security services and the police. On Saturday, I was privileged, as the representative of my party, to join Lady Thatcher, Baroness Scotland and the Metropolitan Police Commissioner at the Yvonne Fletcher 20th anniversary event. That reminded me, if I ever needed reminding, that all police officers can find themselves in the front line and that everyone's life is at risk when in the public service in that way.
	There are two halves to the crime and security debate. First, the Mayor has to ensure that the security of London, not just its policing, is enhanced. I do not take the view that the current Mayor, the commissioner and the Government have done nothing, but I do take the view that more could be done. The public could be given more information and those members of the public who want to contribute could be part of a civil emergency volunteer reserve. Business could be engaged more actively in preparing against terrorism, and it would be helpful for the Mayor to have a seconded adviser from MI5 permanently on the mayoral staff.
	I have suggested to London Underground that it should not continue to explore the use of mobile phones on deep tube lines until we can be sure that they cannot be abused, as terrorists have done in other European capital cities. I was grateful to London Underground for responding positively to my suggestion.
	The most important thing may be to ensure that fanatics and fundamentalists do not lead young members of the minority communities, particularly the Muslim community, astray. We all have a duty to have that dialogue to make sure that they feel fully part of our communities and do not get led into fanaticism, which is a danger with every faith and not just theirs.
	We have a very clear view about crime and have argued from these Benches for many years that every bit of London should have good community policing. To put it simply, we say that there should be a community policing guarantee that goes further than the current programme of the outgoing Mayor and the Government. We call it the "four-by-four proposal". There would be four police and four others in all wards, with the person leading it on a four-year contract. There would be a ring-fenced and guaranteed community police service in all wards, and it would not be taken away. Its implementation will start—as the Met tells me, if I am elected—next year and it will be fully implemented over the following three years.
	I take a zero-tolerance view of violent crime. That is the priority in London. If gun crime is the real menace, and if the police in an area where gun crime is on the rise and is a real threat want to be armed, they should be able to be armed for a temporary period. If a certain group of the police, such as a territorial support group, feel that they need to be armed for a limited period, they should be able to be armed too. That is the way to protect us from an overbearing argument to arm police generally, which I resist. That is something that the police would rather have, too.
	I am afraid to tell the hon. Member for Cities of London and Westminster that I want to refer to his colleague, crime statistics and the way in which the Conservatives are trying to misuse them. We must be careful not to allow the misuse of crime statistics. I understand that they are difficult, but we must have zero tolerance of their misuse too.
	I shall not go into great detail, but I will select those things that seem to me to be important. I appreciate—and the Minister knows this—that the latest crime statistics for the year just ended will not be available until next week, just before the campaign begins. We will then have the latest picture. However, London, I believe, has the second lowest rate of violent crime of the 10 regions in England. The Met, for all sorts of historic reasons, has recorded a higher percentage of crimes than any other police service in England, although police services will soon have a common recording system, which we welcome. I realise that my figures are only recent comparables and I am sure that the Minister will correct me if I am wrong, and I am willing to be corrected. However, my figures show that the percentage of adults who are the victims of violence in London for the last two full years for which figures are available has gone down from 8 per cent. to 5.7 per cent. Indeed, we are not the worst region in England. Yorkshire and Humberside and the south-east have a higher incidence of violent crime. The theft of or from vehicles in London in the last two full years has gone down from 1,472 to 1,205 vehicles per 10,000 households, and that figure is not the highest in England. The figures for the north-west and Yorkshire and Humberside have been higher for both those years than those for London. Burglaries from households in London have gone down from 308 to 284 per 10,000 households. The decline is not huge, but the figure has gone down.
	There have been significant drops in those three categories and the fall has been faster than the average fall across England and Wales. London is sixth—not the worst—out of the 10 regions in terms of violent crime per capita; second out of 10 in terms of vehicle crime per capita, whereas it was first; and third in terms of burglary.
	There is far too much violent crime and far too much crime. There needs to be far less and the clear-up rate needs to be higher. However, it does nobody any good to exaggerate the figures, because that undermines the work that has been done to add to the number of police, which we support, and the commitment of us all to make sure that the streets of the capital are safer. I hope that, from now on, the Conservative candidate will not misrepresent the figures in this election, because that only adds to the fear of, in particular, the vulnerable, the lonely and the isolated in our capital city.
	I have two other one-sentence criticisms. The criticism of the outgoing Mayor is that neighbourhood policing, which has been a Government programme, has not been delivered any more quickly in London than anywhere else, and it could have been. The criticism of the Conservative candidate is that he speaks very good language about dealing with crime, but he puts no additional money on the table, and until we see that his proposals will be paid for people will not believe that there will suddenly be huge numbers of extra police on the streets.
	Another big issue is transport—we all know that. There needs to be more walking and cycling. Scooters, motor bikes and taxis ought to be able to use all the bus lanes all the time, and some of those lanes could be used by cars at certain times of the day. We support the congestion charge and, unlike the Conservative candidate, we would not abolish it but, unlike the outgoing Mayor, we would not extend it westwards to Kensington and Chelsea. We would make it much more user-friendly, including allowing people to pay in advance and, instead of clobbering people with a fine if they forget to pay by 10 o'clock that night, we would allow them to pay up until the end of the following day.
	I have talked to the London Retail Consortium, whose manifesto launch I attended yesterday. Our proposals to have no charge between Christmas and new year, to give people five charge-free journeys a year and to stop the charge at 5 o'clock are very popular with the consortium, the latter because early evening business would not be nearly as badly affected.

John Randall: I do not want to seem critical, but I have been paying my congestion charge in advance, and if the hon. Gentleman wants a lesson I will see him afterwards.

Simon Hughes: I have been paying mine in advance too, so I do not think that it is a problem, but there are many people who forget to pay, or cannot pay, by the 10 o'clock deadline, and they wake up the next morning to find that they will have to pay £40. They are perfectly law abiding, and that charge is not necessary. We could give them an extra 24 hours' grace; I know that would be popular.
	On buses, my argument is simple: of course extra buses are great, and the extra routes are great, but on some of those routes in the middle of the day buses run at a frequency that is not justified by the number of passengers. If the Minister comes with me to Oxford street, or reads what Sir Simon Jenkins wrote about buses in Oxford street, he will realise that at some times of the day one could almost walk the length of that street on the roofs of the buses, which must mean that we are putting too much money into buses. That would be fine if the Mayor had paid for them, but there is a transport deficit of nearly £1 billion. I thought that the Minister might say that that was not a problem because the Government were going to fund it, but I gather that they have not agreed to do so. If they do not fund it, the incoming Mayor, whoever they may be, will have a big difficulty dealing with the legacy of the "spend now, work out how you pay for it later" regime for which Mr. Livingstone has been responsible.
	Tube services could usefully run later, but most importantly they could run more reliably. My hon. Friend the Member for Carshalton and Wallington (Tom Brake), who looked after these matters before me, and others including me, think that one way to achieve that is to have extended periods of closure—for example, for weeks in the summer holidays—so that a lot of maintenance such as track relaying and signal work can be done and some of the endemic problems can be dealt with more quickly.

John Randall: Will the hon. Gentleman give way?

Simon Hughes: I will not, if the hon. Gentleman will forgive me.
	I echo the concerns expressed this week by two Members with south-east London seats, the hon. Members for Beckenham (Mrs. Lait) and for Orpington (Mr. Horam), that the Government do not appear to recognise that the Strategic Rail Authority's mad plans mean that services for commuters in the borough of Bromley will be reduced from about six an hour to, in places such as Chelsfield, about two in three hours. The Mayor should have a say in that, and I hope that the Government will accede to the request that the new Mayor should have some responsibility for commuter trains. In a "PS" to the Minister, if Mr. Livingstone has administered Transport for London so well, how come it always underspends its annual budget and hands money back? Clearly, it cannot be the best-administered part of this capital city.
	Another issue that Londoners raise all the time is the fact that they want a cleaner city, and many of us would argue that there are many ways in which that should, and could, have been done.
	I have two last points to make. First, whatever good things the outgoing Mayor may have done, he has not done the great social justice things that he should have done. He has abjectly failed to deliver affordable housing for Londoners. Labour and Livingstone last year delivered fewer completed, affordable homes in the social housing sector per year than when Labour took office—fewer than 5,000. We need about 15,000 affordable homes a year, but fewer than 5,000 are available. We need about 30,000 new homes a year, but only about 15,000 are being built, so the policy has been a complete failure, even without taking into consideration the lack of money for decent homes, the repair of council housing and so on. When the Mayor came to office, London did not have the highest unemployment rate of the English regions. It was third in the UK league table, but its unemployment rate is now the highest. If the London Development Agency had done its job properly it would be getting people living in Greater London into the jobs in Greater London, not doing things that did not meet most of its targets.
	What should we do next? The Conservatives should stop talking London down and realise that, for their choice of mayoral candidate, who has so many links with people with a financial interest in the running of London Underground, independence is the last word that could be used to describe him. They should explain why, in the constituency of my hon. Friend the Member for Twickenham (Dr. Cable), they circulated the "Richmond upon Thames Borough Herald" which does not even feature pictures of the Conservative candidate on any of its four pages. Indeed, his name is mentioned only once on the back page, and nowhere else. There seems to be a surprising lack of endorsement in a seat that the Conservatives hope to win.
	The Labour party should explain why it still cannot tell us what it is going to do about Crossrail, although everyone in London has been asking for a green light on the project for months. It should explain why it cannot allow the east London line extension to go ahead. We were told that it was going to go ahead a few months ago, but the Government have put the brakes on. Labour should explain whether it will give London the comprehensive spending review settlement that all parties have asked for.
	We will continue to build up our support and work, winning ground from Labour and the Conservatives, and increase the number of our councillors. There were fewer than 100 in the '70s, between 100 and 200 in the '80s, between 200 and 300 in the '90s, and consistently more than 300 this decade. We have won councils from both Labour and the Conservatives, we have made gains in parliamentary seats, we have increased the number of our Greater London assembly members and Members of the European Parliament, and we have won recent elections, such as the one in the constituency represented by my hon. Friend the Member for Brent, East (Sarah Teather). To answer the hon. Member for Hammersmith and Fulham (Mr. Coleman), we fully expect that over the next few weeks we shall not only overtake the Conservatives but provide again the sort of surprise and boost for London that occurred last autumn. There will be a new assembly and a new Mayor who gives value for money, does not waste the public purse, and serves the people of inner and outer London.

Stephen Pound: On a point of order, Mr. Deputy Speaker. Will you help hon. Members and me by telling us whether we are trespassing from the subject of debate into crude electioneering?

Mr. Deputy Speaker: Order. As the Chair has already ruled at an earlier point today, the content of an hon. Member's speech is not a matter for the Chair.

Simon Hughes: In a few weeks, I can promise the hon. Member for Ealing, North (Mr. Pound) that we will engage in full electioneering. He can rest assured that I am on the last paragraph of my speech.
	Some of us are determined to make London an easier and more pleasant city to live and work in, and a more united city of which to be a citizen. We want to make it a city that can win the Olympic bid next year; a city in which we house the homeless and accommodate the badly housed, keep local post offices and chemists instead of closing them, reduce unemployment while increasing skills, education and prosperity—

Andrew MacKinlay: God's heaven on earth.

Simon Hughes: Absolutely, I am grateful to the hon. Gentleman. We want to create in the capital city a place that will be regarded as God's heaven on earth, where he, I and the people outside are proud to be, not some of the time but all of the time, and of which we can say that this is not just a great city, a great London but a greater London still.

Clive Efford: The issues raised by the hon. Member for Southwark, North and Bermondsey (Simon Hughes) in relation to policing in London sounded very much like step change, and did not reflect any innovation by the Liberals. He said that the precept would not need to be increased by large amounts of money to provide all the wonderful extra services that we would enjoy across London, so presumably they will be funded by a windfall tax from somewhere like the tooth fairy, like most other Liberal policies.
	I welcome the hon. Member for Cities of London and Westminster (Mr. Field) to the Front Bench. I think that this is the first occasion when he has spoken from the Front Bench, and I am sure it will not be the last. His speech was full of scaremongering about safety issues, street crime and the anti-terrorism measures that everyone wants taken to secure London for the future. He made much of the increase in taxes that Londoners have been required to pay over the past few years, but he failed to point out that 85 per cent. of the precept has gone to London's policing, which is why we are seeing such a large increase in the number of police officers across London, and that 4 per cent. of that sum has gone towards increased work on intelligence and to counter terrorism and the threat of terrorism in London. He failed to recognise that much has been done across London.
	The British crime survey does not bear out the hon. Gentleman's arguments. The risk of being a victim of crime in London is at its lowest for 20 years. Vehicle crime and domestic burglary are the lowest for 20 years. We have reversed the trend towards an increase in burglary that began in 1993. There are 1,900 police community support officers, and we are on target to introduce 4,000 by 2005. Another Tory myth is the amount of paperwork. In order to reduce the amount of paperwork that police officers must undertake, 1,200 forms in the police service have been made obsolete. That has occurred across a number of police forces, not just in London.
	On police numbers, we have passed the 30,000 mark for police officers in London. The Mayor's aim is to increase that to 35,000. A telling figure from the British crime survey—or rather, in an article in The Economist of 30 November; I do not want to misrepresent the British crime survey—is that one in 115 employed Londoners will be employed as a serving police officer when we reach that 35,000 target. That is an incredible number, and we are well on the way to achieving the target.
	The comparisons that have been made with Rudolph Giuliani in New York are not borne out by experience. In the period from 1991 to 1994, when Giuliani had his biggest success in reducing crime in New York, the Home Secretary of the day was responsible for London's policing. That was the right hon. and learned Member for Folkestone and Hythe (Mr. Howard). The Tories tell us that crime is one of their biggest issues and they put it at the top of their agenda, so one would expect the activities of the Tories to mirror what was going on in New York, but of course it did not. The reason that Giuliani achieved a massive reduction in crime in New York was that he increased the number of police officers, exactly as the Mayor is doing in London now.
	Since 1993, the number of police officers in London has gone down consistently. They peaked in 1992 at 28,000 and by 1997, when the then Home Secretary left office, they were down to 26,677, and they continued to fall. The backdrop to that was the fact that a large number of London's police officers who had been recruited in the 1970s were reaching the end of their period of service and approaching retirement. It was not a shock that such a reduction would come about. It was well known and well documented, and something needed to be done to address the enormous reduction in the number of police officers that we faced at that time in London.
	Nothing was done, and to add insult to injury, not only was nothing done, but the Home Secretary of the time, the right hon. and learned Member for Folkestone and Hythe, adopted the recommendations of the Sheehy report, which reduced the salary of police officers in London. As a result of reducing the London living allowance, serving officers who came into the force after 1 September 1994 were paid less than officers who had joined the force before that date. That resulted in a massive reduction in the number of police officers. Within six months of the implementation of the report's recommendations, London's police were down by 1,178 officers.

Richard Ottaway: Before the hon. Gentleman turns to Liberal Democrat policy, will he confirm that the total figures that he is giving include the community support officers, as those numbers will make quite a difference? Does he recognise that a future Conservative Government would substantially increase the number of policemen on the streets of London? The key point is not just the numbers of policemen on the beat, but what is done with them and the way in which they are organised. There is a great need for reform of the way in which the police operate, and the success of Mayor Giuliani in New York was very much based on targeting specific problems. Does the hon. Gentleman recognise that that is the key to combating crime, and not just police numbers?

Clive Efford: I shall come to that point later. I thought that the hon. Gentleman was going to apologise for reducing the number of police officers in London and for contributing significantly to the rise in crime. The statistics show that that reduction in police officers kicked off an enormous increase in crime across London that continued until 1999, when the rate of the increase started to level off. The level has continued to increase, but the rate of increase has now started to come down. There is a straightforward correlation between the number of police officers and the crime rate. The reduction in the number of police officers in London lead to a crime wave across our capital city, and there is no getting away from that fact.
	On scaremongering, the Conservatives' advertisement in today's Evening Standard has prompted an unprecedented response from the Commissioner of Police of the Metropolis, who has vehemently denied the claims made in the advertisement and has gone so far as to issue a statement and letters to mayoral candidates demanding that they temper their claims and ensure that they are based on facts, as they are adding to the problem of fear of crime across London.
	Let us consider the crime rates. Street robbery is down 20 per cent.; burglary in London is the lowest for 25 years; reported burglary is down to a 27-year low; street crime is down one third; and murder is at 200 a year and has remained steady, despite the claims made by the hon. Member for Cities of London and Westminster. As I said earlier, when Giuliani reduced crime in New York, he reduced it to 1,000 a year, so we are not talking about figures that bear comparison—

Simon Hughes: The murder rate was reduced to 1,000 a year.

Clive Efford: I am grateful to the hon. Gentleman for pointing that out.
	The suggestion that the figures bear comparison misleads Londoners and is scaremongering in the extreme. It is an attempt to create a fear of crime that is not justified. Furthermore, I point out to the hon. Member for Cities of London and Westminster that Mr. Norris will have a great deal of difficulty in delivering on the claims that he has published. That suggests that he does not think that he will ever have to deliver on them or that he will ever win the election. The rate of reduction in crime in London will make it difficult for him to halve crime and mirror the achievements of Mr. Giuliani.
	This is the first year in which we have had a Mayor in London, and the Mayor's achievements on policing and creating safer communities are considerable. He has increased police numbers to more than 30,000, and that trend is set to continue, but his most significant contribution is the introduction of step change. We have begun to move police officers into the community and to work with local communities to address the fear of crime. In spite of the decrease in those crimes that have been targeted, the one area on which the hon. Member for Cities of London and Westminster is correct is fear of crime, which remains frustratingly high.
	Fear of crime is due to antisocial behaviour on our streets, and that is where step change will make a big difference. Our police officers must be seen within their communities, their approach must be intelligence-led and they must be in contact with the local community to identify the minority, who have a disproportionate effect on crime rates and on the fear of crime in our communities, in order to make Londoners feel safer in those communities. Step change is being introduced in 100 wards across London and it will make a significant contribution—we must work with local communities to address the fear of crime. No responsible politician should claim that there is a widespread crime wave across London and that Londoners should justifiably feel under threat.

Linda Perham: My hon. Friend is ably telling us about improvements in policing, police numbers and community support officers. Does he agree that local communities are reassured by the presence of street wardens, which is another Government initiative?

Clive Efford: There are many initiatives, and there also partnerships between local authorities, businesses, communities and others. Strategies to tackle crime and communities have significantly contributed to reducing crime and the fear of crime. We must tackle our constituents' concerns, and the hon. Member for Cities of London and Westminster misrepresented the issue.
	The Mayor has done a remarkable job on not only policing and community safety, but transport and other areas. We must all appreciate that London, as the capital city, makes an enormous contribution to Britain as a whole, and that to denigrate our capital city is self-defeating in the extreme. To suggest that our transport network is in a parlous state, that London's streets are not safe and that we will shut down the underground during the main period for tourists is away with the fairies. It is absolutely essential not to overstate the problems that any major city inevitably faces, but the hon. Member for Cities of London and Westminster has done that.

John Horam: My hon. Friend the Member for Beckenham (Mrs. Lait) made two excellent interventions, and, typically, my right hon. Friend the Member for Bromley and Chislehurst (Mr. Forth) intervened on a point of order, so it is entirely appropriate that I, the hon. Member for Orpington, should contribute, thus making a full hand from Bromley.
	Bromley is a great borough, and a wholly Conservative borough, which has wished, from time to time, that it were not in London and that it had remained in Kent. It has particularly wished that over the four years—not, as the hon. Member for Eltham (Clive Efford) said, just one year—that we have had a Mayor of London. Millions of residents in outer London pay a fortune into Ken Livingstone's budget and get precious little in return.
	I am glad to see my hon. Friends the Members for Uxbridge (Mr. Randall), for Upminster (Angela Watkinson) and for Croydon, South (Richard Ottaway), because I am sure that they agree that this has been a disastrous period of mayoralty for the leafy suburbs. I believe that that alone constitutes a reason for getting rid of this now Labour, formerly independent, Mayor. I think that even my hon. Friend the Member for Cities of London and Westminster (Mr. Field) would agree that he has been above all a zone 1 Mayor, and that the contribution that he has made to the lives of the millions of people in outer London is negligible.
	Let me cite the example of crime. Hon. Members have said a lot about crime statistics. I venture into that area with great certainty, because I know for a fact that the number of police in the borough of Bromley is no higher than it was in 1997. We have not benefited in any way from the extra police who have appeared in London as a whole. I do not know where they are, but they certainly have not come to Bromley. As the hon. Member for Eltham said, there is a correlation between crime and police numbers, but there is also a correlation between antisocial behaviour and police numbers. As the Minister pointed out, antisocial behaviour is a growing problem—and it is very evident to local residents, who often care about it more than the terrible crimes that they rarely see committed. Antisocial behaviour and yobbery are seen on a day-to-day basis in suburban areas of London, as well as in the city. Places such as Bromley have no more police to deal with the situation than they had six or seven years ago, which is a tragedy for residents.
	According to the figures that my right hon. Friend the Member for West Dorset (Mr. Letwin) gave when he was shadow Home Secretary, the Conservative approach would give 200 extra police to a London borough such as Bromley. Even then, adding an extra 200 to the 450 or so we already have would only give us the same number as there are today in the borough of Lewisham. That is the extent to which my borough is disadvantaged by the current system. I beg the Minister—although it is not his direct responsibility, but that of the Mayor—to bear in mind that some boroughs will continue to get a raw deal as a result of the way in which the financing of policing in London is organised.

Stephen Pound: I am grateful to the hon. Gentleman for giving way to me, although the House usually is not so grateful. As the Member for Ealing, North, the leafiest of the leafy suburbs, I can tell him that we have reason to be grateful, not only because we have more police officers, but because, crucially, we have a say in how many are recruited and how they are deployed. That never happened when we had one Friday morning debate a year on the matter. Will the hon. Gentleman tell me whether he is happy with the existing structure of the Metropolitan Police Authority and would wish to retain it?

John Horam: First, I contest the hon. Gentleman's claim that Ealing is the leafiest of the London suburbs. I am sure that he would agree that the green belt is rather larger in Bromley than it is in Ealing, so we certainly have more trees, and therefore more leaves.
	Leaving that aside, I would certainly want to change the structure to some extent. There should be more direct election of police forces—indeed, that is part of our policy—because if an area's policing priorities are decided by the people of that area, they are much more likely to reflect their wishes than if they are decided by some remote bureaucracy in another part of London. If that is what the hon. Gentleman is saying, I agree with him; but let us see it happen on the ground, because it has not happened in any real sense so far.
	That deals with crime. The Mayor has a lot to answer for in neglecting the millions of people who live in the outer suburbs of London, and I believe that he will pay dearly for that in the forthcoming election.
	Transport is the other big issue in the election and in this debate. No one could seriously deny that transport has been a disaster area for this Government. I fully recognise that the problems caused by the underfunding of London's transport do not go back only seven years, but have antecedents in previous Governments—not only Conservative, but Labour. I do not blame Ken Livingstone, or even Ministers on the Front Bench or Transport Ministers, for that—I blame the Chancellor of the Exchequer. He has been one of London's biggest enemies, despite presiding—luckily for him—over an amazing economy, of which London is the centre, as we all agree.
	The Chancellor has displayed a wholly negative approach to financing the London underground in the past four or five years. We wasted much time when simple things could have been done. Labour Members, as well as Conservative and Liberal Democrat Members, have said that what needed to be done to solve, for example, London Underground's problems, was obvious. The Government have stalled for five years, during which we have got almost nowhere. The Labour Chancellor, a Scotsman, has had much to do with the endemic problem.
	Ken Livingstone has admitted that things will not get better in the next decade. The London underground has reached such a pass, with, for example, constant closures and maintenance problems, which we all experience in our daily lives, that there can be no significant improvement for a decade. The Mayor has said that and it is a disastrous comment on the Government's performance.
	My hon. Friend the Member for Beckenham made an important point about the Strategic Rail Authority plan that is known as the integrated Kent franchise. It is a problem not merely for Kent, but for all the train services that come to Kent through south-east London. As my hon. Friend said, the SRA proposes to cut services to Hayes by one third. In Petts Wood, which is a larger station than Hayes, services would be cut by half. Fifty per cent. of peak hour services will be cut from Petts Wood under SRA proposals. At Chelsfield, which the hon. Member for Southwark, North and Bermondsey (Simon Hughes) mentioned, the SRA proposes cuts in peak hour services of two thirds.
	Places such as Petts Wood, Hayes and Chelsfield were built up in the 1930s around the railway stations. That is why they are there. As house prices increase in central London, more people move to Petts Wood, Chelsfield and Hayes because they recognise that those areas have a reliable railway service. However, insecurity has been forced upon them. They do not know what will happen and they are writing in their hundreds to my hon. Friend the Member for Beckenham and me about the proposals. Creating such insecurity in transport is disgraceful. What are people to do if the proposals are accepted? We are not considering overcrowding. If peak services are cut by half, people will not even get on the platforms, let alone the trains. What will such cuts do to house prices in those areas? The position is appalling.
	The SRA presented the proposals in an unsatisfactory way. It issued a document that was full of jargon and did not compare the proposals with the current position. No one therefore had a clear view of the comparison. It refused to reveal many of the statistics that lay behind the proposals, so that those affected did not know the information on which they were based. It consulted only local authorities and other stakeholders; it did not consult the passengers, who know from daily experience what the train services are like. However, few passengers were included in the loop or knew anything about the proposals. It is therefore unsurprising that the three-month consultation period has, in practice, become a month. People have taken time to wake up to what would happen under the proposals.
	Although I appreciate that it is not her direct responsibility, I tell the Minister for Crime Reduction, Policing and Community Safety, who currently occupies the Front Bench, that my hon. Friend the Member for Beckenham and I intend to fight the SRA proposals all the way down the line. They are impossible proposals and I have written at length to Richard Bowker, the chairman of the body. I warn Ministers that unless they take the matter seriously and reverse the proposals, I shall be down on them like a ton of bricks. The proposals must be ruled out of court; the Government must stop them.

Linda Perham: London is my city. I was born here, I represent a seat in a London borough and I have lived here all my life. I welcome the Opposition's choice of debate today, but it is a pity that it seems only to be a cloak for beefing up the chances of their mayoral candidate. I do not welcome their carping and whingeing about our great capital, which they did very little to improve during their 18 years in office. Furthermore, the public spending cuts that they propose would certainly not benefit London.
	When people who are not Londoners complain about London, my city, it reminds me of a time when I shared a house in Ealing, North some 30 years ago.

Stephen Pound: Not with me!

Linda Perham: Not with my hon. Friend, I hasten to add. My housemates were all from other parts of the country, and if they complained about London, I would say to them, "Why are you here? You've come down here to work and live, and you've been given a job and a home, so don't complain about my city."
	The Tory motion has a sweeping moan about the quality of life and, astonishingly, about the insecurity resulting from the threat of terrorist action—a subject that the hon. Member for Cities of London and Westminster (Mr. Field) covered at some length. What place is safe from the threat of terrorist action? Who would have thought, 30 years ago, that Birmingham and Guildford might be targets for terrorism? We had to be ever vigilant, however, during that time, particularly in London, given the threat from the IRA, which we faced for decades.
	I pay tribute to the excellent work of the Metropolitan police and the British Transport police and their vigilance against potential terrorism, especially in the light of the recent arrests, one of which took place in my constituency. As has been mentioned, the number of officers working in counter-terrorism, security and protection has been increased by almost 1,000 since 9/11, through the Home Office and the Metropolitan Police Authority.
	What is the next thing that the Conservatives complained about? Rising levels of crime and antisocial behaviour. Other hon. Members have talked about the commissioner's statement that London has one of the lowest rates of violent crime and is still one of the safest major cities in the world. As for antisocial behaviour, the Home Secretary has driven through tough measures in recent years to tackle that problem. I do not remember the Conservatives introducing many antisocial behaviour Bills.

John Randall: Does the hon. Lady get more complaints about antisocial behaviour now than she did three or four years ago?

Linda Perham: Complaints about antisocial behaviour are probably on a level, but my point is that this Government have recognised the problem and are introducing measures to tackle it, particularly in relation to nuisance neighbours. They are taking action against the people who cause problems to others. I mentioned street wardens in my intervention on my hon. Friend the Member for Eltham (Clive Efford), and I welcome the step change programme, which will counter some of the problems of officers being called in for duties in central London.
	The Conservatives' next whinge was about overcrowded and unreliable transport. That is a result of the decades of under-investment by both Governments that the hon. Member for Orpington (Mr. Horam) mentioned, and of the lack of subsidy from previous Tory Governments. I was never the greatest fan of public-private partnerships, but much-needed investment is now going into the tube. Nor, I must confess, was I ever the greatest fan of our new Labour gain Mayor, but I do salute his success with the congestion charge and the improvements that he has made to bus services, increasing their use by 30 per cent. Closed circuit television has also been installed on buses, and whose safety and cleanliness have also improved.
	I chair the all-party group on Crossrail, and I welcome the Mayor's enthusiastic backing for that project.

Simon Hughes: Is it going to happen?

Linda Perham: Well, the Secretary of State has expressed his support and backing for the Crossrail project, but financing is a problem. There is a lot of money involved. At the end of the day, however, the Government have made a commitment to it, and I know that it will be of enormous benefit to London. It will link the key business areas of the City and Canary Wharf to Heathrow, with huge increases in jobs. It will enhance our standing as the best financial district in the world and as one of three global financial centres. It will have a benefit-cost ratio of 1.99:1 and will contribute about £19 billion to the British economy. The regenerative benefits of Crossrail alone include 40,000 new jobs in the Thames gateway, so the regeneration aspect will be a huge boost to the London economy and the economy of the whole country.
	There have been six regeneration projects since 1997 in my London borough, two through the London Development Agency, the town centre development through the sustainable communities fund, and the three single regeneration budget projects including a health ladder social inclusion project.
	On health, there have been vast improvements to my two local hospitals since 1997. King George hospital in Ilford is now a two-star hospital, which has been improved by a cancer centre and a primary care walk-in centre, which opened this month. At Whipps Cross hospital, in which my hon. Friend the Member for Leyton and Wanstead (Harry Cohen) and I have taken a great interest in recent years, there will be a redevelopment of the whole hospital site worth £331 million, and lots of other improvements including a new renal unit and an upgrading of cardiac services. Last year, primary care services spent £400 million on schemes such as community volunteers, mental health, health improvement and user involvement and regeneration. My local health centre will be improved vastly through a new local improvement finance trust programme. Continuing improvements have taken place in reducing waiting lists and times in primary and secondary health care.
	In education, children's services have been transformed, with vastly improved opportunities for parents who want their children to have nursery education at age three and four. The Sure Start scheme, which I hope to get in my area—there is already one in Ilford, South—has been an enormous success. A new museum has also been provided under the new lottery scheme, which is wonderful.
	In my experience, the words "failing public services" in the Opposition motion do not apply either London-wide or locally. Services are improving thanks to the commitment and investment of the Labour Government and the London Mayor, in policing, transport, regeneration, health, education and the whole spectrum of life in London. As far as I am concerned, London is the greatest city in the world. A Labour Government and a Labour Mayor have been good for London. The re-election of a Labour Mayor and a third term for a Labour Government can only mean that things can only get better.

Angela Watkinson: It is almost impossible to generalise about London, as its 32 component boroughs are so diverse. The London borough of Havering, for example, which includes my constituency of Upminster, is 50 per cent. green belt, and appears to have more in common with our Essex neighbour in Brentwood than with our nearest London neighbours, Dagenham and Redbridge. The difference between outer and inner London boroughs is even more pronounced, in terms of socio-economic profile, environment, density of population and development. Each has its own specific problems and advantages, which is why the provision of public services is such a challenge. Education and health services for the people of Greater London must reflect the widely varying circumstances and range of needs that prevail in all those diverse boroughs.
	All-London averages of general health indices are similar to those for the nation as a whole. Of course, that masks the individual differing statistics in individual boroughs. Life expectancy and infant mortality, for example, are worse in Lambeth, Southwark and Newham than in Richmond, Bromley and Kensington and Chelsea. There also seems to be a gender divide in life expectancies, which is greatly accentuated in poorer areas and reflected in the national average. That particular phenomenon has always intrigued me. Women in poorer areas often combine family and domestic responsibilities with several part-time jobs outside the home, often of a fairly arduous nature, over a number of years; yet their life expectancy seems to overcome all the odds. It is a tribute to their survival abilities that somehow they still seem to outlive men. I do not know the explanation, but statistically that seems to be the case.
	The demand for health care outstrips the capacity for supply, and always has. It follows that in a densely populated area like London that effect will be exaggerated. Most GPs, for example, are overworked and have significantly more patients on their lists than is recommended by the national health service. Many of the traditional single practitioners are likely to be replaced on retirement by group practices in health centres, as property and staff costs in London are too high for newly qualified GPs to set up in single practice.
	As more GPs reach retirement age, recruitment in London will become more and more of a challenge, particularly in outer London boroughs like Upminster, which fits neither the very rural nor the inner-city profile—both of which are particularly attractive to new GPs. Hospitals in London tend to have more staff per head than hospitals elsewhere, because they also treat patients from all over the country; but according to statistics from finished consultancy episodes, which are used as a standard measure of hospital activity, the 37.9 per cent. increase in funding for health care in London has been translated into only a 1 per cent. increase in hospital activity, and waiting times for consultant appointments and operations remain a serious concern for my constituents.
	One of the main challenges is increasing the capacity of the health service to enable it to keep pace with ever-increasing demand and expectations. I welcome the Government's aim not just to allow patients to book every hospital appointment and elective admission by 2005, with a choice of convenient date and time, but to allow them to choose the hospital in which they will be treated. London has a natural advantage, in that it has more hospitals and a transport system. Sixty-three per cent. of patients involved in the London patient choice project exercised that option.
	It makes absolute common sense to take advantage of the spare capacity in the provision of health care wherever it is—in an NHS trust, a treatment centre or a private hospital, or with a specialist primary care practitioner. It matters little to the patient who the provider is; it is the quality of care that counts. The NHS needs all the help it can get, from wherever it can get it. There are many opportunities for the public and private sectors in London to work together to mutual advantage and, more important, to the benefit of patients in shortening their waiting times.
	Whereas health professionals should be free to make clinical decisions, it is the function of Government to create the conditions in which they work and to take a wider strategic view of improving the health of Londoners. Preventive measures play an essential role in reducing demand for health care. For example, London has a higher mortality rate from asthma than England and Wales as a whole, despite having a lower proportion of individuals receiving treatment for asthma. Strategies to improve air quality through engine efficiency, to discourage smoking, to reduce alcohol and drug abuse, to combat obesity and to encourage immunisation take-up all contribute in general to improving public health and quality of life for Londoners, while helping to reduce future demand on the NHS.
	Tuberculosis rates have risen consistently in recent years, and new drug-resistant strains have developed in eastern Europe. People coming to this country from some of the accession countries in Europe are more likely to choose London than anywhere else in the country to live and seek work. There will be specific health problems attached to that, and the NHS will have to cope with them as well as with superfluous numbers.
	At a time when both A and E departments and GP surgeries are under tremendous pressure from the sheer numbers of patients, the expansion of the role of pharmacists in the NHS is one way—which I know the Government are considering—in which capacity to treat could be increased. It would also be more convenient for patients. Where could be more convenient to access preventive medicines such as smoking cessation, contraceptive or dietary advice than in the high street chemist?
	If the relevant professional bodies were receptive to the idea, pharmacists could also prescribe as well as dispense. After all, they have a comprehensive knowledge of prescription drugs and a personal relationship with their regular customers, which makes them ideally suited to play an increased role, and densely populated areas such as London lend themselves to pilot schemes.
	I know one pharmacist in my constituency who recognised the sound of a particular cough when two of his regular customers came in to buy cough medicine and advised them to go home and get their gas fire checked—it was found to have dangerously high emission levels, and that piece of advice could have been life saving, which demonstrates the level of personal service that pharmacists already provide and shows how readily their role could be expanded.
	The diversity of London boroughs brings challenges in education that match those in health. Havering schools have an excellent reputation and there is fierce competition for places. Indeed, many schools are doing very well, so raising the standard of London's failing schools to the level of the successful ones is a priority. The success of a school rests largely with the head teacher. An inspirational head teacher motivates staff, parents and pupils alike, but it is an uphill struggle in schools where there is little parental interest, a high level of absenteeism, discipline has broken down and disaffected pupils are emboldened by their knowledge of the limitations of the disciplinary measures available, their perceived rights and the threat of litigation. That minority of pupils has a disastrous effect on the education of the rest, who suffer disruption of their lessons and the resulting low morale in their teachers.
	Removing from the classroom pupils who are unable or unwilling to behave in an acceptable way is the first essential. Finding the reasons for their behaviour and ways to modify it is a separate and difficult challenge, but it is essential to redirect those disaffected pupils so that they do not leave school unfit for employment, with low self-esteem and unable to interact with other people in a socially acceptable way. These are the very pupils who would benefit from high-quality vocational training. Anyone who lives in London knows how difficult it is to find a plumber, electrician or bricklayer without having to wait for six months. These practical skills are in great demand and can offer more secure employment opportunities than many very popular degrees such as media studies and information technology, which are reaching saturation point, and would not involve the attendant university student debts.
	It may be that more flexibility in the curriculum would benefit failing schools. Head teachers might feel that learning and achievement in core subjects could be encouraged in other ways, for example through the introduction of more sport, music or drama. A creative head teacher knows his or her own school and what changes could be tried to help to turn it round. Once a school becomes unpopular and the numbers fall, its funding is affected. This can lead to staff losses and a downward spiral towards unviability.
	Recruitment and retention of teachers in London is also affected by high property prices. Outer London boroughs such as Havering have a higher proportion of older, experienced teachers, who are extremely valuable to the school but are at the top of the pay scale, which makes staffing costs very high. Schools often lose newly appointed teachers to inner London, where the additional allowance makes all the difference in meeting the cost of housing in London. Some of my head teachers have travelled as far as New Zealand and South Africa in search of staff, when the normal procedures have failed to attract applicants. Some very enthusiastic young teachers have been found by this rather drastic method and they have been very popular with the children, but the drawback is that they may not stay very long.
	There are two areas of concern that affect both health and education equally: sex and drugs education. Rates in London of serious sexual diseases such as HIV/AIDS, chlamydia and hepatitis B have risen dramatically, echoing the rise seen nationwide. Last year, the Health Committee declared itself "appalled" by the crisis in sexual health. Although parental responsibility is the dominant factor in the guidance of children, sex education in schools has a strong influence, and if misguided can do untold damage. The reluctance to moralise and the simple provision of information have in effect condoned sexual promiscuity in some young people. Safe-sex education has ignored abstinence messages and led to many young people becoming sexually active long before they are emotionally mature enough to cope with the consequences. Girls need to be warned of the likely outcome of having sex with a boy who has no interest in getting married or becoming a parent, and who has no income to support a child—[Interruption.] I am sorry if hon. Members think that that is amusing.
	A teenage girl will find that 24-hour-a-day single motherhood in a free council flat is not the exciting adventure that it might have seemed to her, when her education is brought to an abrupt halt, she can no longer go out shopping or clubbing with her friends and her baby is effectively fatherless. Sex education has often given too much information and too little guidance. This is not a subject on which we can afford to be non-judgmental, as our alarming teenage pregnancy statistics demonstrate. The figures are the highest in Europe.
	I take a similar view of drugs education, in that it has relied on the neutral provision of information to young people before they have the maturity of judgment to deal with it. The Home Office website "Frank" is enough to tempt many impressionable young people into experimenting with drugs. I apologise because I have made these points in the House before, but I shall give examples from the "Frank" website:
	"If only illegal drugs came in packets with instructions on the outside";
	and:
	"Give the first drug plenty of time to kick in before taking another one."
	There are lots of examples like that, although I shall not go on because I know that time is short.
	Drugs education material for use in schools gives more details about illegal drugs, their effects, how they are administered—

Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Lady, but I think that I need to remind her at this stage that the debate should relate specifically to London.

Angela Watkinson: My apologies, Mr. Deputy Speaker; I was making the point that the drugs problem is worse in London than elsewhere.
	It is no good telling young people all about drugs in great detail, then saying, "OK, now you decide." The problem is greater in London than in the country as a whole, although it is greatest in areas such as Lambeth and Lewisham and less bad in more affluent areas such as Richmond and Kingston upon Thames. The Minister will know that I have consistently opposed the Government's policy on the declassification of cannabis and their view on its contribution to the drug problem.
	In those respects, education and health in London are inextricably linked. Advice, enforcement, policy and treatment need a co-ordinated strategy if the problems are to be tackled effectively. London is one of the largest and most densely populated cities in the developed world. The people who live in it are its greatest resource, and they deserve the very best public services.

Karen Buck: That excellent London journal Time Out recently ran a series of articles on the theme of whether London should declare independence. Although I would not go quite that far yet, it had one excellent idea: an anthem for London. Among the candidates were those superb songs, "The Dark Streets of London" by The Pogues and "London Calling" by The Clash. I am glad to see that that dirge by Ralph McTell did not make it into the top 1,000, but my personal favourite reminds me of when I arrived in London in the late 1970s: the Leyton Buzzards', "Saturday Night Beneath the Plastic Palm Trees". It includes those superb lines:
	"Dancing to the rhythm of the guns of Navarone,
	Found my Mecca near Tottenham Hale station,
	I discovered heaven in the Seven Sisters Road".
	That is exactly what arriving in north-east London meant to me and, although I have transferred my affections to Ladbroke Grove and the Harrow road since then, I remain very much in love with this city, in all its diversity, mess and creativity.
	It is because I love London that I am perfectly happy to argue London's case and point out where we need policies and investment to tackle some of London's problems. We have challenges indeed. Many of those are the challenges of success arising from diversity, rapid population growth, turnover and mobility and the exceptional costs that we face, particularly in housing. Those challenges have made the delivery of public services much harder in London than in almost any other part of the country.
	Because I love my city so much, I am always happy to point out that many people are not sharing in the general growth of London's economy and its benefits. The recent figures on below-average income households showed that inner London was losing out, particularly in respect of tackling child poverty. I was disturbed to note that no Conservative Member made any mention of poverty whatever. If we are to transform London, we have to transform it for all Londoners. After 25 years of active political campaigning and representation in London, I have no doubt that only one party is prepared to provide the resources, policies and leadership necessary to rise to the challenges and make the changes for London.
	Events over the last few days have amply demonstrated that in respect of policing, crime and safety. The Government have supported the expansion of the number of police officers in recent years with a huge amount of funding. Additional investment of more than £300 million has been made in the past three years alone, and the Mayor has added £184 million raised through the council tax precept. Since 2001, the Conservative group has voted against the budget on every occasion.
	Reference has been made to the step change neighbourhood policing scheme, which was launched in Brent a couple of weeks ago and, at the same time, in Queen's Park ward in my own constituency. It represents a very welcome development indeed and the key question is who is going to pay for it and similar expansion under the Conservative or Liberal Democrat plans. Conservative spending plans prioritise health and schools, but say nothing about how to preserve policing budgets. On the day after the launch of step change in Queen's Park, my local newspaper, the Wood and Vale quoted Graham Tope, the Lib Dem London Assembly member, as saying that the scheme would prove
	"too costly for the capital".
	He also said:
	"Such a financial burden should not fall on London council taxpayers",
	which raises the question of who is going to pay for the Liberal Democrat expansion of police services, as outlined by the hon. Member for Southwark, North and Bermondsey (Simon Hughes). We cannot have a wish list for police resources without a commitment to funding.

Stephen Pound: My hon. Friend knows that about a fortnight ago on a Friday night in Northolt, my constituent, Akberali Mohamedally, was murdered. Thanks to the exemplary work of the borough co-ordinator, Stuart McNair and the borough commander, Martin Bridger, a suspect was arrested within 24 hours. Does my hon. Friend agree that community-based policing is something that we simply cannot afford to go without? We simply have to have it. Talking about paring back at this stage is almost criminal. Labour Members cannot and will not tolerate that.

Karen Buck: I completely agree with my hon. Friend. Community and neighbourhood policing is what people want, and it is paying dividends. As another example, the same local newspaper mentions Deputy Chief Inspector Richard Wood of Marylebone police station, who is responsible for a halving of robbery and theft in the Marylebone division of Westminster. He is quoted as saying:
	"I am not being arrogant, but we are solving 33 per cent. of all crime in Marylebone and 20 per cent. of robbery and snatch theft. As far as I know, that's the best record in the Met."
	In my home patch, as well as across London, we are seeing a real improvement in detection and clear-up rates.
	My hon. Friend the Member for Eltham (Clive Efford) and others provided figures on London-wide reductions in crime, so I shall not repeat them now. However, violent crime is an issue that rightly worries most people. After a particularly horrific drive-by shooting in north Kensington last week, it also worries me a great deal. We should remember that, thanks to the effectiveness of Operation Trident, gun crime fell by 47 per cent. in 2002–03, which also saw a 6 per cent. rise in detections.
	Extraordinary progress has therefore been made in tackling a wide range of offences, including violent crime. My local police and the Metropolitan police generally should be warmly congratulated on the effectiveness of their operations, rather than open to the sort of criticism applied by the Conservative candidate for Mayor. Remarkably, he implies that he will secure improved policing results out of the same or possibly even a reduced budget. How is he going to do it? Supposedly by working with the Met to place crime at the heart of policy. How can he work with the commissioner when his advert today screams out that London is the most violent city in the country, that crime is rising remorselessly—which is untrue—and warns, despicably in my view, that
	"your child's journey to school is at risk"?
	How despicable is it to frighten children and parents, and their communities, with baseless assumptions drawn from the figures published by the Met? Do the Conservatives honestly believe that slamming the Met's recent record will improve relationships or the delivery of services?

Andrew Dismore: As my hon. Friend will know, Mr. Norris has form in that area. At a Police Federation meeting, he made claims about crime figures and fell out with Sir John, who said that the statistics quoted by Mr. Norris were misleading. Sir John said:
	"I'm not going to sit here and listen to those figures. They are from a Tory think-tank, Civitas. Figures from the Met show violent crime is down by 5 per cent."
	How can Mr. Norris work with the commissioner when he is constantly at war with him? Or does Mr. Norris intend to sack the Commissioner of Police of the Metropolis like he intends to sack the commissioner of transport for London?

Karen Buck: My hon. Friend is right. I have criticised the Conservative mayoral candidate and challenged some of the figures from Opposition Members, but it would be wrong to say that all Conservatives are critical of Government policy. At a community safety awards ceremony a few weeks ago, the leader of Westminster city council, that flagship Conservative borough, thanked police and council staff for all they were doing in
	"bringing down crime and improving our streets".
	He also quoted figures that confirm a
	"massive 53 per cent. fall in street crime and a 9 per cent. drop in violent crime."
	Those figures mean 6,889 fewer victims of crime overall.
	The Westminster Reporter, produced by the borough's award-winning communications team—which rivals that of the GLA for size and cost—states that
	"we are pleased to report a significant reduction in a number of crime categories . . . and a close working relationship with the Met".
	That is something that Steve Norris would do well to emulate. The royal borough of Kensington and Chelsea also has its say, with press releases headed, "Streets are safer as police blitz royal borough" and "More police community support officers on patrol in Kensington and Chelsea". At least Conservative boroughs in central London have given a warm welcome to the strategy introduced by the Government and the Mayor.
	On crime figures, should the public trust the Metropolitan Police Commissioner, their local boroughs and a Government who have increased police strength from 27,536 in 1997 to more than 30,000 today? We know that one crime is one too many, but a crisis of confidence in policing stoked up by irresponsible comments also damages people's well-being. Instead, we should congratulate the police and praise the Government on the additional investment that has been made to improve the quality of life of Londoners.

John Randall: To be honest, because of its timing, this debate has not been one of our best debates on London. Labour Members accuse us of overstating the case, but we could accuse them of complacency. I have lived in my area all my life and I know that people think that things have changed dramatically. I am not sure that we can blame any political party for that, but in the past two weeks, and less than a mile from my house, we have seen a tuberculosis outbreak in a local school, terrorist suspects arrested and a bus attacked by a gang of youngsters. That is typical of the experience of many people and they feel a sense of desperation about it. The Government have introduced legislation such as the Anti-social Behaviour Act 2003, but just passing a law does not stop the behaviour.
	As the elections draw near, I hope that we can all agree on one thing. London is a diverse capital city, which has always been one of its great strengths. When we go out to campaign in the streets, we must all ensure that racists and the British National party get nowhere and we must not use anything that would make life easier for such people.

Patrick Mercer: It is a pleasure to follow my hon. Friend the Member for Uxbridge (Mr. Randall) in the debate and to echo his words about racism, which all of us need to bear in mind.
	Before I go any further, I wish to tell the hon. Member for Ilford, North (Linda Perham), whose speech was extremely interesting, that I think that I am the only non-London Member present and I will do my best not to moan about her city or, indeed, to draw any inimical comparison.
	Almost all hon. Members today have spoken, in one form or another, about security, crime and terrorism, on which I intend to major in a moment. The hon. Member for Eltham (Clive Efford) gave an interesting deposition on crime and the policing points were well made. Similarly, my hon. Friend the Member for Orpington (Mr. Horam) came in with an extremely well-put series of points on crime and rail, where he was joined by my hon. Friend the Member for Beckenham (Mrs. Lait). The hon. Member for Regent's Park and Kensington, North (Ms Buck) referred in particular to crime, along with poverty. All those speeches were illuminating, but I shall concentrate on the point on which my hon. Friend the Member for Cities of London and Westminster (Mr. Field) majored: the interface between crime, security and terrorism.
	This morning, a number of people were arrested in Manchester. In my shadow capacity, I would be the first person to emphasise the fact that, of course, terrorism is not simply a problem that will be concentrated around the London area. However, Riyadh was also attacked this morning. In the past two or three years, the major attacks—Washington, New York, Bali, Madrid and, again, Riyadh—have all taken place in capital cities, so the capitals will get it. There is absolutely no doubt that—I think that I am paraphrasing the hon. Member for Belfast, West (Mr. Adams)—we have got to be lucky all the time; the terrorists have only got to be lucky once and, if they can pick off a capital, they will do so.
	I do not believe for one moment that it is easy to stop the terrorists getting through. Again, to paraphrase a great socialist, the bomber will always get through—although he was not necessarily talking about terrorist bombers: in that case, it was Nazi bombers. That is a fact: it is almost impossible to stop. There is no doubt that the Government have done certain things, but I should like to underline some ideas that, I hope, will make their efforts more focused and to echo one or two criticisms—they do not necessarily come from the Conservative party, but from other parties—about the way that things are being done at the moment. I hope that the Government will accept what I say as constructive, rather than destructive.
	My first point is that we had some vocal interventions, particularly from the Under-Secretary of State for Transport, the hon. Member for Harrow, East (Mr. McNulty), when we were talking about the level of exercising in the emergency services in the capital. There is no doubt that plenty of exercises have taken place in the capital, but to the best of my knowledge, there has been only one thorough field training exercise, to use military parlance: in other words, an exercise done live, on location and involving the emergency services—the blue-light services—in a situation that is as realistic as possible.
	Of course I am talking about OSIRIS II, which, strangely, happened on the second anniversary, or thereabouts, of the events of 11 September. Although the Government are to be congratulated on getting on with that exercise, it took them a very long time to get round to doing it. I was there, as was the hon. Gentleman and several other hon. Members who are here today, and it struck me that it was the most basic form of exercise. I would expect to see such an exercise five or six weeks, not 105 or 106 weeks, after a major terrorist incident.
	When will Ministers get round to holding an exercise or series of exercises that practise our emergency services when traffic is on the streets, pedestrians are about and the situation is thoroughly realistic? They have not yet done that. It is a little like sending soldiers into action without ever giving them the chance to use live ammunition. Blank ammunition is just fine but, at some stage, we have got to accept the opportunity cost and get on with things. We must say, as our American colleagues do, "I'm sorry, but we are going to interfere with trade and business for the next few hours and physically practise our response." The consequences of people saying in the media that their son, daughter, husband or wife had died because the emergency services had not been given an opportunity to practise would be horrific. If the Government want an example of that, they should examine the Spanish media after the Madrid bombings.
	I also draw the Government's attention to a document that has already had a bit of an outing and which is known as "Project Unicorn". Its aim was to study what the commercial sector in London might do to assist the police counter-terrorism efforts. It was commissioned by the Metropolitan police, took a long time to produce and was extremely expensive. Its conclusions, which I note with interest that the Government have yet to publish, make fairly damning reading. The first point is that
	"The Commercial Sector appears to be unanimous in its criticism of the present CT Communications Policy prior to a major incident: they find it outdated, condescending, generally uncoordinated and at times incoherent."
	Several Members have already mentioned the need for a proper public information campaign. I note with interest that, during the proceedings on the Civil Contingencies Bill when we brought this idea up, we were completely and totally stonewalled by the Government. We were told that the matter was being dealt with and that we should not seek to scare the pants off the population. The population had to be alert but not alarmed. However, as soon as the Madrid incident occurred, the outstanding work of the police on the underground and the Metropolitan police produced public information campaigns warning people about what might happen, what to look out for and to be alert to exactly the points that we had been making to the Government. I urge Ministers to come back on this point and tell us why a much more coherent policy has not been followed to tell the population what is at stake.

Clive Efford: I refer the hon. Gentleman to the motion that he and his colleagues have tabled for this debate. It does not say anything about the fear of terrorism. The Conservatives appear to lack a policy for London, so should we not get back to the motion and start discussing the issues rather than trying to stir up the fear of terrorism in the way that Conservative Members have throughout the debate?

Patrick Mercer: I point out that I was quoting from a document, the aim of which was to study what the commercial sector in London might do to assist the police in their counter-terrorism efforts. There is an unparalleled opportunity for the people of London to be used as eyes and ears for the security services. That would make terrorism much more difficult.
	Project Unicorn says that there is a
	"perceived lack of a central focus for CT in Government which is accentuated by the belief that Government does not always understand the commercial implications of CT . . . For the vast majority of businesses in London this is accentuated by the lack of a coherent Communications Policy and confusing terminology such as 'Resilience' or 'Preparedness'."
	I could go on, but I will not. However, it is crucial that London stops trying to glue together this jigsaw of counter-terrorist efforts, listens to the points that the Metropolitan police are making and tries to start to use the private and commercial sectors in particular. It should try to use all the security guards, who are already halfway trained in such skills, and to enrol people to fight the battle alongside them.
	I wish to pick up a point that I heard being made, rather surprisingly, by the hon. Member for Southwark, North and Bermondsey (Simon Hughes). We should look much more imaginatively at raising something like an emergency volunteer reserve whereby we use the skills, abilities and motivation of individuals to help the Government, as cheaply as possible, to prepare physically for an attack that we have been told, rightly or wrongly, is inevitable.
	The report goes on to make points about, in particular, the lack of understanding of the chemical, biological and radiological threat to London. It says:
	"To the public at large the CBRN threat is undoubtedly the most frightening aspect of 'the new terrorism', but it also the one that Government says the least about. It is little surprise therefore that the media fills the vacuum and the public assume the worst. Whilst the more astute commercial security directors have produced their own CBRN guidelines and contingencies, they are loth, in the absence of any official direction, to promulgate them."
	I say to the Minister for Crime Reduction, Policing and Community Safety, please can we look at that advice, which comes from a wholly objective source, and do something about it? Let us see the report published and a campaign for public information and training put in place.
	My hon. Friend the Member for Cities of London and Westminster has already mentioned the civil contingencies reaction force. That very slender force was the only answer that the Government came up with relatively quickly to try to produce more muscle after 11 September. It never reached its 7,000 operational target, but—I do not want to be churlish about this—it is better than nothing. The force exists and can be called on.
	The Ministry of Defence has told us that the most effective of the 14 civil contingencies reaction forces is that founded by the London Regiment. Yet the London Regiment—not all of it, but two companies—has been called up and is serving in Iraq. I wonder how many soldiers from London were involved in the four explosions in Basra this morning. Why were they there? Why were they not in Bermondsey, where they should be, doing their job? Has the Minister raised that with the MOD? Has she made it clear that London, above all areas, needs to have forces that will prevent threat from turning into reality? If that does not happen, I very much regret that the political consequences that we saw after the Madrid attacks may well come to pass in this country.

Hazel Blears: As a northerner, I am delighted to have the opportunity to wind up this debate. Like the hon. Member for Uxbridge (Mr. Randall), I have heard excellent contributions on a range of issues from Members with constituencies right across London, and my knowledge of the city has been dramatically enhanced by listening to the debate. The debate has highlighted London's position.
	We have heard a bit of an own goal from the Opposition, and I wonder just how in touch with his constituency the hon. Member for Cities of London and Westminster (Mr. Field) is. The leader of Westminster city council comes to see me regularly to tell me how well the crime figures are doing in his area, how the council has tackled antisocial behaviour and how it has used all the new powers provided by the Government dramatically to reduce crime in Leicester square over the past few months. Yet the hon. Gentleman spent the whole of his contribution telling us how policing is not working, crime is out of control and antisocial behaviour is a problem. If he talks to officers on his doorstep he will find that things are getting a great deal better.
	I want to restate our Government's commitment to London's continuing economic, social and cultural success and to the way in which it is enhancing its status as a world-class city. It is crucial to me, in my part of the country, that London continues to do well, that it is a magnet for inward investment, that it drives the economy of the rest of the country and that it helps to ensure that we have record numbers of people in work throughout Britain. As many Members have said, we also now have record police numbers, including the new community support officers, and more police officers on the beat. There has also been a massive increase in bus services throughout the capital and in the number of people using them. There is a range of things in London of which we can be proud.
	Following the references to the Beach Boys and the Pogues this afternoon, I am grateful that the hon. Gentleman and my hon. Friend the Member for Regent's Park and Kensington, North (Ms Buck) did not join together on one issue, and that was in singing the proposed London anthem. However, every Member who spoke conveyed a genuine sense of pride in representing London.
	My hon. Friend the Member for Ilford, North (Linda Perham) made an excellent speech in which she outlined action by the Metropolitan police on antisocial behaviour and discussed the step change programme. She conveyed her own pride in being a Londoner and highlighted the fact that the Tory motion was—I hesitate to use these words—a long whinge that talked London down and lacked self-confidence. There was no London pride among the Conservatives.
	My hon. Friend the Member for Eltham (Clive Efford) provided an analysis of support for policing, and praised the work of community support officers, who are on the beat, day in, day out. They are not distracted from their work, establish relationships with local people, and are making an impact in my hon. Friend's community.
	There was an interesting competition between the hon. Member for Orpington (Mr. Horam) and my hon. Friend the Member for Ealing, North (Mr. Pound) about which was the leafiest borough in London. I am not in a position to decide the issue, but I can tell them both that the deployment of police resources in London is an operational matter for the police. Resources will be directed to the areas of greatest need, but they will know that the introduction of the step change programme will result in 100 new teams of officers across London. In every single borough there will be three teams of police officers and community support officers dedicated to local neighbourhood reassurance policing, which is what local people have told us they want. Wherever people are in London—in a leafy borough or an inner-city area—they will get better policing and better reassurance.

John Horam: The hon. Lady made the point that we will get teams throughout London boroughs, but only three wards out of 30 in a typical borough will benefit. What will happen in the other 27?

Hazel Blears: The hon. Gentleman wants more, although we have obviously made an extremely good start. His party opposed the precept in the budget of £184 million extra for policing. He cannot have his cake and eat it—he cannot have extra police officers unless he is prepared to find the money for them.
	The hon. Member for Upminster (Angela Watkinson) spoke about the health service and education. The health service in London, as in the rest of the country, is improving enormously as a result of Government decisions to increase investment in the NHS, slash waiting times, increase choice and make sure that people across the capital can get better health services in future. I urge her to re-examine her party's policy on the patients' passport, which, far from being a passport, would be an exit visa from the national health service and would not lead to improvements in services for local people.
	I am afraid that I was disappointed by the contribution of the hon. Member for Southwark, North and Bermondsey (Simon Hughes). He praised crime reduction in London, and I was grateful to him for going through the figures. As he said, the latest figures will not be available until next week, but for some years they have shown that London is safer place in which to live and work and for businesses to operate in. We are making genuine progress, and I was grateful to the hon. Gentleman for his remarks. However, on antisocial behaviour, he has an extremely poor record. His party voted against the Third Reading of the Anti-social Behaviour Bill, and in that debate he said that
	"we must ask ourselves whether, if we were in government, we would want the Bill on the statute book, and the answer is no".—[Official Report, 24 June 2003; Vol. 407, c. 991.]
	That comment will come to haunt the hon. Gentleman because, in typical Liberal Democrat fashion, not all his councillors share his view, and hold different opinions in different areas of London. One power in the Anti-social Behaviour Bill to which the hon. Gentleman took particular exception was the power to disperse people who were intimidating and harassing local people. There have been huge problems on the Butts Farm estate in Feltham, including stalking, intimidation, threats to kill and abusive and threatening language, often targeted on vulnerable residents. It was decided to use the dispersal powers in Feltham, and a Liberal Democrat councillor said:
	"This will have a benefit for the law-abiding majority of youth and residents. . . They have nothing to fear . . . but the people who commit anti-social behaviour have."
	The hon. Gentleman takes one view; his councillors take another view. That is a familiar situation among Liberal Democrats.

Simon Hughes: The Minister would not dare pretend that there is never a difference between the Labour Front Bench team and any Labour member anywhere in the country. Does she agree that things are often much better when there is a partnership? Will she commend my borough, run by Liberal Democrats, which the other day was given by her colleague the Minister a beacon award for community safety for the measures we implement on the ground, which are the best in London and the best in the country?

Hazel Blears: I understand that the foundations for the partnership, which takes a long time to mature, were laid when the council was under Labour control, but I am delighted to pay tribute to local authorities throughout the country and across London that are working hard in their community safety partnerships. I understand that about £30 million has gone into those partnerships over the past year in order to make that significant difference for us.
	I want to highlight the success in reducing street crime across London—a 21 per cent. reduction in robbery, and 11,000 fewer victims. Sometimes we forget the human cost when we speak about numbers and percentages, and 11,000 fewer people were robbed in London as a result of the action taken by the Metropolitan police and their partners. I am also delighted that youth crime is down 7 per cent. in the past year alone. Our young people are the citizens of the future, and it is vital that they are able to live in a safe community. We speak a great deal about young people and antisocial behaviour, but quite often young people are the victims of crime as well. The vast majority of our young people are good, decent young people who make a positive contribution to our community.
	Many hon. Members mentioned the record numbers of police in our capital, about which I am delighted. The Conservatives spoke about an extra 40,000 police officers, but they have gone very quiet about that in recent months. Since they found they could not fund that as well as the fantasy island asylum policy, we have heard little from them. Today we heard from the Opposition that they are interested not in extra police numbers, but in how they are deployed. The Labour Government, however, have a record of extra police numbers across London and extra community support officers.
	I shall deal with the issues raised by the hon. Member for Newark (Patrick Mercer) about resilience and preparedness in London. The local response capability is one of our key building blocks. That is why it is so important that at the centre we keep in touch with the locality and with London about preparedness. I can tell the hon. Gentleman that regional resilience teams are in place in every Government office. In future, the Government offices will be much better organised and in a much better position to tackle not just the terrorist threat, but any of the civilian threats that we face.
	But the hon. Gentleman is right. The threat from terrorism remains real and serious. It is a worldwide issue. It is not unique to the UK. It will be with us for the long term. That is why it is vital that we plan properly. I am delighted to be able to tell him that we are putting an extra £61 million into the Metropolitan police service next year to help it counter the terrorist threat. Since September 2001 we have taken a range of measures to strengthen our anti-terrorism legislation, to make sure that people cannot hide behind the immigration and refugee protections, to proscribe terrorist organisations and to increase the funding not just for the Government offices in London but for the fire service, which for the first time has all its staff trained on CBRN.
	The hon. Gentleman mentioned the exercises that have taken place. I can tell him that hundreds of exercises have taken place across London. They take place weekly. The exercise that he highlighted, OSIRIS II, is only the most visible exercise, but we have had three major command and control exercises, also connected with the military, making sure that we keep in constant contact with them. The hon. Gentleman raised the issue of the business community. The business community is totally engaged with our preparations and is part of our structure. He spoke about the need for public information—

Patrick McLoughlin: rose in his place and claimed to move, That the Question be now put.
	Question, That the Question be now put, put and agreed to.

Question put accordingly, That the original words stand part of the Question:—
	The House divided: Ayes 143, Noes 308.

Question accordingly negatived.
	Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments):—
	The House divided: Ayes 302, Noes 169.

Question accordingly agreed to.
	Main Question, as amended, put and agreed to.
	Resolved,
	That this House takes pride in London's heritage and status as a leading global capital city; notes that its outstanding success over many centuries has depended upon its rich mix of people, innovation and energy; further notes that it is an international leader in financial services, the arts, media, higher education, medicine and scientific research and tourism; welcomes the Government's commitment to London's continuing economic, social and cultural success, and to enhancing its status as a world class city; applauds London's high levels of productivity and success in attracting inward investment that benefits the whole of the UK; recognises that this success is backed by record levels of funding from this Government for education, health, the arts, culture, creative industries, crime prevention, transport and other key public services that have resulted in substantially higher employment, substantially lower unemployment, record police numbers including more community support officers and police on the beat, massive increases in bus services and people using them, with an extra 100 million bus trips and an extra 180 million Tube journeys taken a year; applauds the leadership of the Mayor of London, working in partnership with the Government in the key areas of transport, planning, economic developmnent and policing; praises the work of the police and security services in remaining vigilant to keep the capital safe; and condemns outright Opposition attempts to talk down and undermine the continued success of our great capital city.

DEFERRED DIVISIONS

Motion made and Question put forthwith, pursuant to Orders [28 June 2001 and 6 November 2003],
	That at this day's sitting, the Orders of the House of 28th June 2001 and 6th November 2003 relating to deferred Divisions shall not apply to the Motion in the name of Mr Ben Bradshaw relating to Protection of Animals during Transport.—[Mr. Jim Murphy.]
	Question agreed to.

PROTECTION OF ANIMALS DURING TRANSPORT

Motion made and Question put forthwith. pursuant to Standing Order No. 119 (European Standing Committees),
	That this House takes note of European Documents No. 7969/01 and ADD1, Report from the Commission and draft Regulation on the ventilation in road vehicles, carrying livestock on long journeys and No. 11794/03, Commission Communications and draft Regulation on the protection of animals during transport and related operations and amending Directives 64/432/EEC and 93/119/EEC; and supports the Government's objectives of seeking a significant improvement in animal welfare during transport and better enforcement of those rules throughout the European Union.—[Mr. Jim Murphy.]
	Question agreed to.

LARYNGECTOMY

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jim Murphy.]

Tom Clarke: The catalyst for this debate can be traced back to a letter that I received from the Lanarkshire Speakeasy group. Contained in the letter was a poignant plea for support for people who had developed cancer of the larynx and ultimately had to have a laryngectomy. The letter was signed by Ann Muir, of whom I will say more later.
	My principal aim tonight is to highlight the plight of laryngectomees, and in particular how they are treated in relation to applying for disability living allowance. There is a genuine belief in the group that they are not being treated fairly. I look forward to the response of my hon. Friend the Minister, and I welcome her presence.
	In terms of local government boundaries, the group encompasses North and South Lanarkshire councils, which have a population of 628,000 people. It is a voluntary group whose purpose is to offer hope and encouragement to laryngectomees—people who have had their voice box removed due to cancer of the larynx—and to families and carers. Its prime objective is to ensure that all members, of whom there are approximately 100, are included in all aspects of community and social activities. One of its most significant achievements is to encourage people back into society after radical surgery, as laryngectomees often withdraw from contact outside their own family circles. The secretary of the group, Ann Muir, is an outstanding person, possessed of an amazing fighting spirit. I believe that there is no praise too high for this remarkable woman.
	Let me explain to the House what laryngectomy is all about. Ann Muir has told me of her own experience. Often people are unaware that they may have a problem until certain symptoms become evident. They include hoarseness or change in the normal voice lasting for more than three weeks, breathlessness or difficulty in breathing, difficulty in swallowing, a cough or chest infection and a swelling in the neck. After a family doctor has been consulted, a series of tests will be carried out to check a patient's general health and confirm or rule out a cancer diagnosis.
	The lowest point for any patient is the simple shock of being told "You have cancer." It is at that point that every cancer patient knows what may be facing him or her. Ann underwent radium treatment for six weeks on 33 separate occasions in order to avoid a laryngectomy. A special mask was made for her, and she was bolted on to a table for treatment. Despite Ann's bravery, she admitted that that was a most frightening experience. The larynx, or voice box, has three main functions: to allow the air that we breathe to reach our lungs, to protect the lungs by closing when we swallow food or drink, and to project our voices when the vocal cords vibrate.
	As the radiation treatment was insufficient, Ann was told that she must have a laryngectomy. Cancer of the larynx is quite rare, affecting fewer than 3,000 people each year in the United Kingdom. More men than women develop it, usually after the age of 50—although only the other day I was talking to a woman whose partner, aged just 43, has just had a laryngectomy.
	A total laryngectomy is an operation to remove the larynx completely. Just think what that must be like. Following the operation, breathing and communicating will be done very differently. Patients are so medicated for the first four to five days that they are completely confused. Ann said that at that stage she saw herself in a mirror. Visitors would say that she was looking well; Ann's response was that if she was looking well, heaven knows what she would look like when she was ill.
	One week after the operation, a patient's face and neck are massively swollen. There are holes in the neck and tubes coming out everywhere, with pain control the only salvation. Ann's granddaughter visited her and said "Gran, I don't like those. They look like teeth in your neck." The youngster was not to know that the metal stitches and the clamps were to hold Ann's head together.
	For surgical voice restoration, a catheter was inserted through a small hole in the back of Ann's trachea. The catheter keeps the hole open so that the voice valve can be put in place later. Once all that has been overcome, the next phase—that of learning to talk—begins. Removal of the larynx means that talking can no longer happen naturally, and the way in which a person breathes has been altered permanently. When that process is complete, the real task of rebuilding the person's life truly begins.

Huw Edwards: I am sure that my right hon. Friend will want to join me in paying tribute to those medical specialists who perform this procedure, including those at the Singleton hospital in Swansea who treated my father four years ago, when he was 83. He is alive and well, and speaking well, following that operation.

Tom Clarke: I am extremely grateful to my hon. Friend for that timely intervention. His high regard for the medical profession is widely shared by those with experience of this condition.
	The pain, suffering and inconvenience of all that I have just described inevitably lead to a permanent life change. Families have to make adjustments to help a person cope. There is the psychological impact of coming through such a traumatic experience, all the time thinking that one could have died.
	In my discussions with Ann, I also met another laryngectomee, Bill Wright, who is the chair of the Lanarkshire Speakeasy group. What struck me was the love and devotion of his wife Ellen, who explained that since his laryngectomy she has never had a proper night's sleep. Without complaint, she constantly lies awake listening to her husband breathing, with great difficulty, during the small hours of the morning.
	In preparation for this debate, I consulted various bodies, not least the Department for Work and Pensions office in my constituency. I had a meeting with Mr. David Collie, who is my main point of contact on all DWP matters. Two other representatives from the disability benefit centre were at the meeting. The purpose of the consultation was to establish what the DWP provides in terms of service to constituents. At the conclusion of my speech, I will return to the pre-eminent role that the DWP should perform on this issue. For now, I record my thanks for the Department's co-operation both nationally and locally so far.
	Assessing a disability living allowance form in the first place is not as easy as one might think. For example, my local DWP office does not have a DLA application form available. Filling in such a form or forms would be an ordeal for most people, never mind a person who has just undergone major surgery. Someone said to me, "You would need to be a Philadelphia lawyer to cope."
	The fact is that there are two sets of explanatory notes accompanying two forms. DLA 1A section 1 has 68 questions, with 141 options. DLA 1A section 2 has 159 questions, with 188 options. Is all this really necessary? When DLA was first introduced, a DLA form was available in the Benefits Agency offices. A member of staff used to spend an hour or longer helping people to fill in the form. That staffing resource is simply not available in today's restructured offices. Before somebody points out that all a person needs to do is telephone for assistance, I remind the House that we are talking about laryngectomees—people who do not find it easy to talk, and certainly not for as long as it would take to complete the DLA forms.
	Why does it have to be a paper application? Are there no alternatives that take into consideration the person's needs and disabilities? Moreover, when one finally gets round to completing the forms, we are entitled to ask how they are dealt with. In the office that processes the applications, there are trained decision makers, with supervisors to keep them right and even doctors available if they need to consult on any medical matters. The Department of Work and Pensions has all the resources to hand, and all its needs are covered in full. But what about the client? Inevitably, tonight I want to focus precisely on those clients.
	Is it any wonder that when Ann Muir was starting up her voluntary group and visited every person in Lanarkshire who had experienced a laryngectomy, she was appalled at the standard of neglect that she discovered? I have no wish to exaggerate the position; there was not neglect in every home. However, there was sufficient evidence of such neglect in more instances than I believe should have been the case. It cannot be right that when a person has suffered all that is involved, they then arrive at such an unacceptable stage.
	A new study on the problems faced by people affected by cancer when assessing benefits in Northern Ireland has revealed that many lose out on the financial support to which they are entitled. The report "Benefits Access for People Affected by Cancer in Northern Ireland" is the result of a project undertaken jointly by Macmillan Cancer Relief and the Northern Ireland Social Security Agency. Interviews with patients, carers, health and social care professionals, agency staff and other advice centre workers helped to identify the main barriers that people affected by cancer face when attempting to access benefits.
	Heather Monteverde of Macmillan said that the outcome of the report confirmed what Macmillan had been hearing from patients for years. She said:
	"Our experience has told us that financial concerns are second only to physical pain as a cause of stress for people with cancer and their carers. We're delighted that the Social Security Agency has worked with us on this project to get a clear picture of the problem. We now look forward to the implementation of the recommendations."
	She concluded:
	"By working together, we can ensure that people affected by cancer get the benefits advice and support they so clearly need."
	In my view, Heather is absolutely right.
	What do I want to see on the ground for people who have had a laryngectomy and others with cancer? I want to see the DWP take a leading role in bringing together health, local government and other agencies to analyse the scale of the problem. I want to see joined-up government in action for the people who need it. I want cancer patients to be made aware of what benefits they are entitled to claim. I want experts such as welfare rights officers to help to complete those labyrinthine application forms.

Jim Sheridan: It is right that during this debate we focus on the individuals and the financial implications for them, but does my right hon. Friend also accept that organisations such as Macmillan Cancer Relief struggle day in, day out to supply their service? It is now time for the Government to consider tax exemptions for such organisations.

Tom Clarke: I am grateful to my hon. Friend. I am sure that the Chancellor and his colleagues in the Treasury will take his important point on board.
	I want cancer victims to have automatic representation to tribunals. Again, the best people to do that would be welfare rights officers. I want an end to cancer patients and their families worrying about coping, and I trust that our debate has made a helpful contribution to that.
	I conclude with a quote from Mr. Forth, who was interviewed for the Northern Ireland report. He said:
	"People with cancer shouldn't have to fight for benefits, when all effort is in fighting cancer itself."

Maria Eagle: I begin by congratulating my right hon. Friend the Member for Coatbridge and Chryston (Mr. Clarke) on securing the debate and on putting his points in way that we have all appreciated. I also pass on my thanks and admiration to Ann Muir, Bill Wright and other constituents of my right hon. Friend who run Lanarkshire Speakeasy. I do not believe that any Minister who deals with these issues could find any way of replacing the sort of work that Ann and Bill do in their local communities. We have national systems, but the sort of work done by volunteers in local communities is irreplaceable. I pass on my thanks for the work that they do. They have also given my right hon. Friend valuable information to help with his preparation for the debate. There is no better way for Members to find out what it is really like than to talk to people in their own constituencies.
	Laryngectomy is indeed the severe and radical procedure that my right hon. Friend has graphically illustrated. There is no doubt—the Department does not dispute it—that many of those who have undergone it will be eligible for disability living allowance. One of the consequences of laryngectomy is total loss of speech, although voice production can, as my right hon. Friend and my hon. Friend the Member for Monmouth (Mr. Edwards) explained, be reacquired.
	Disability living allowance is a tax-free, non-contributory and non-means-tested benefit, the purpose of which is to provide a contribution towards the extra costs faced by severely disabled people as a result of their disabilities. Entitlement to the allowance, as my right hon. Friend is well aware, is not linked to a specific diagnosis of particular disabling conditions. It is not a medicalised benefit in that sense. It is based on the requirements of people with disabling conditions for additional care or mobility help, so it is a very individually based benefit, depending on the effects of a disabling condition rather than its diagnosis. However, there is no doubt about the fact that people who have undergone laryngectomy qualify for the benefit on the same basis as any other disabled people—in other words, they have to meet the entitlement conditions.
	DLA has a care component and a mobility component, and the care component is most relevant to the particular condition. The care component has three rates. There is a higher rate for people who are so physically or mentally disabled that they require from another person any of the following: frequent attention throughout the day in connection with their bodily functions; continual supervision throughout the day in order to avoid substantial danger to themselves or others; prolonged or repeated attention at night in connection with their bodily functions; or watching over for a prolonged period or at frequent intervals at night in order to avoid substantial danger to themselves or others. There is a middle rate for people who have those needs during the day or at night, and a lower rate for people who require attention in connection with their bodily functions for a significant portion of the day, or who cannot prepare a cooked main meal for themselves if they have the ingredients.
	Whether or not those entitlement conditions are met on individual claims is determined by decision makers on the basis of the facts of the case. The forms to which my right hon. Friend drew attention are there by way of self-reporting packs, which are designed to enable our decision makers to understand the particular needs of any individual. I recognise and have frequently said that forms of the length and complexity illustrated by my right hon. Friend can undoubtedly prove a barrier to people applying. However, help is available. It is not the case that our staff will not assist. Our increasingly sophisticated information technology, which the Department has recently acquired, enables staff to present individuals with a much shorter form, based on their individual needs as determined by questions from staff to elicit which sections of the form are most relevant. That is usually done through telephone helplines, but I take on board my right hon. Friend's point that those who have had laryngectomies cannot be expected to answer reams of questions on the phone. It would not be comfortable or indeed possible for many of them to do so.
	The Department is committed to making its services accessible. Indeed, we are required to do so under the Disability Discrimination Act 1995. If clients have difficulty with communication, as many people with laryngectomies clearly do, we will make appropriate arrangements to ensure that they can access our services properly. Those arrangements may include home visits or other methods, but it is not in doubt that the Department is committed to ensuring that everybody who might benefit from our services has access to them. I would be more than happy to discuss with my right hon. Friend's constituents the ways in which that can be achieved in their area or how we could do it better. The point that my right hon. Friend made about access is very important. The last thing we want is for people to worry about how they can let us know about their requirements and we have got much better at providing an individual service tailored to those who wish to apply to us.
	However, not everybody who applies will succeed. People's needs vary, not only based on their diagnosis but based on other factors. I am not saying whether those who have had laryngectomies are likely to succeed or fail, because applications will be decided on individual assessments by decision makers. My right hon. Friend is correct to say that staff in the Department—the decisions makers—have access to doctors and advice to ensure that they sufficiently understand the implications of laryngectomy to make proper decisions about the applications received. The Disability Living Allowance Advisory Board also provides guidance—it was last updated in 1999—that gets across the seriousness of such cases and the care that someone who has had a laryngectomy may need.
	I hope that there is no excuse for our decision makers getting decisions wrong in a vast array of cases. I would expect them to get the decisions right more often than they get them wrong. However, I take on board my right hon. Friend's point that it is important that clients themselves and those who wish to apply can do so in any way that they find comfortable and helpful, and it is certainly our intention to ensure that they can do so.
	To respond to some of my right hon. Friend's other points about bringing together agencies and joined-up government, all of us in government aspire to making central Government services more accessible locally and more meaningful to the individuals who are trying to gain access to them. As he made it clear, they have enough difficulties in their lives, in dealing with laryngectomy and the health implications of living with cancer, so they should not have to negotiate the obstacle course that they can face in their dealings with various Departments and local government—and who knows which other type of local public service they can come across? We do our best to ensure that such things are improved.
	I do not pretend that we have achieved perfection—no hon. Member would believe me if I tried to suggest that we had—but, none the less, we recognise that it is important that our services exist for the benefit not of my staff or anyone else's staff in a different Department, but of our customers and clients. We are for ever trying to find new ways to ensure that people such as those to whom my right hon. Friend has drawn our attention today have every opportunity to get what they need from us. We are committed to ensuring that those who are entitled to such benefits receive them speedily and in a way that is relevant to them.
	I agree with my right hon. Friend that more information is required. We can always do better in that respect. There is often fear among disabled people and those who have acquired a disability or who are living with cancer or another serious condition, and they want to concentrate on getting better and on living with their condition, not on trying to work out the finances. We understand that we always need better information about where individuals can find the relevant help.
	On some of my right hon. Friend's other points—I realise that time is escaping us—I am more than happy to write to him to ensure that I deal with any issue that I have not covered. I assure him that those who are living with laryngectomy have just as much entitlement to disability living allowance as anyone else and that we are not just administrators of the benefit. We are committed to ensuring that those who are entitled can gain access to their entitlement.
	My right hon. Friend drew the attention of the House to the forms that are used, and we are committed to reforming the way in which those forms work in a way that helps those who may have an entitlement to claim properly and to pass the information on to us. We are more than happy, where necessary—it clearly is necessary in some cases—to make proper arrangements to enable people to complete those forms in a way that is comfortable and useful to them. May I finish by saying how grateful I am to my right hon. Friend for raising this important matter on the Adjournment today?
	Question put and agreed to.
	Adjourned accordingly at four minutes to Eight o'clock.